Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT14577 | FL |
N | 225XM0800X | Mental Health | OT14577 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT14577 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT14577 | FL |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT14577 | FL |
NPI | 1912285248 |
---|---|
Provider Name | Mrs. Keira Nakita Gandy |
First Address | Fort Lauderdale, FL 33314-6757 |
Second Address | Fort Lauderdale, FL 33314-6757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 03/08/2011 |