Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 2813 | FL |
NPI | 1023175809 |
---|---|
Provider Name | Mrs. Patrice Ann Freeman |
First Address | Davie, FL 33330-4724 |
Second Address | Davie, FL 33330-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8810605 | (05) | FL |