Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT-7918 | FL |
NPI | 1194207209 |
---|---|
Provider Name | Mrs. Robin Hancock Bongiovanni |
First Address | Longwood, FL 32779-4726 |
Second Address | Longwood, FL 32779-6171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |