Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4713 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | 4713 | FL |
NPI | 1245822519 |
---|---|
Provider Name | Mrs. Paula Leslee Brosz |
First Address | Saint Johns, FL 32259-8218 |
Second Address | Jacksonville, FL 32223-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |