Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 002465 | GA |
N | 224Z00000X | Occupational Therapy Assistant | 16678 | FL |
NPI | 1013475821 |
---|---|
Provider Name | Mrs. Amy Beth Whitcombe Freeman |
First Address | Crawfordville, FL 32327-2688 |
Second Address | Quitman, GA 31643-3913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |