Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 9369 | FL |
NPI | 1770085656 |
---|---|
Provider Name | Mrs. Merina Lee |
First Address | Daytona Beach, FL 32114 |
Second Address | Daytona Beach, FL 32114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2018 |
Last Update Date | 08/03/2018 |