Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT12269 | FL |
NPI | 1508385287 |
---|---|
Provider Name | Mrs. Tara Cunningham |
First Address | Belle Isle, FL 32809-3538 |
Second Address | Belle Isle, FL 32809-3538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT12269 | OT LICENSE NUMBER (01) | FL |