Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 9911 | FL |
NPI | 1003156811 |
---|---|
Provider Name | Mrs. Jessica Darlene Hasto |
First Address | Melbourne, FL 32934-7229 |
Second Address | Melbourne, FL 32934-7229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2013 |
Last Update Date | 15/02/2013 |