Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 10740 | FL |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10740 | FL |
NPI | 1942631577 |
---|---|
Provider Name | Mr. Freddie Antonio Holmes |
First Address | Tallahassee, FL 32317-2218 |
Second Address | Tallahassee, FL 32308-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2013 |
Last Update Date | 05/04/2017 |