Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 4846 | FL |
NPI | 1316175425 |
---|---|
Provider Name | Mrs. Christa Maria Jansen Van Vuuren |
First Address | Lakeland, FL 33811-1641 |
Second Address | Lakeland, FL 33813-3113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 26/06/2009 |