Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT15458 | FL |
NPI | 1366078107 |
---|---|
Provider Name | Mrs. Amanda Halks |
First Address | Tampa, FL 33625-1641 |
Second Address | Tampa, FL 33634-5330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2020 |
Last Update Date | 12/03/2020 |