Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT14713 | FL |
Y | 225XG0600X | Occupational Therapist - Gerontology | OT14713 | FL |
NPI | 1821340944 |
---|---|
Provider Name | Mr. Jia Yu |
First Address | Boca Raton, FL 33486-2238 |
Second Address | Boca Raton, FL 33486-2284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 10/12/2018 |