Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT14271 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT14271 | FL |
NPI | 1053769802 |
---|---|
Provider Name | Mrs. Jennifer Stuckey |
First Address | Bonita Springs, FL 34135-4311 |
Second Address | Fort Myers, FL 33912-4323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 01/06/2016 |