Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 1539 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 3331 | NC |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 14154 | FL |
NPI | 1063538031 |
---|---|
Provider Name | Mr. William Alan Kopke |
First Address | Gulfport, FL 33707-5805 |
Second Address | Largo, FL 33770-3536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 10/01/2016 |