Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 15199 | FL |
NPI | 1003268418 |
---|---|
Provider Name | Mrs. Lisa Santiago |
First Address | Palm City, FL 34990-7721 |
Second Address | Palm City, FL 34990-7721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2016 |
Last Update Date | 09/07/2016 |