Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 13603 | FL |
NPI | 1184968745 |
---|---|
Provider Name | Mrs. Diane Elaine Cavic |
First Address | Punta Gorda, FL 33983-5936 |
Second Address | Venice, FL 34285-6421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 20/11/2012 |