Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | COTA/L9763 | FL |
NPI | 1760610877 |
---|---|
Provider Name | Mr. Joe Micheal Lowry |
First Address | Lakeland, FL 33813-3113 |
Second Address | Lakeland, FL 33813-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 26/06/2009 |