Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT13703 | FL |
NPI | 1043562283 |
---|---|
Provider Name | Mrs. Vanessa Taylor |
First Address | Fort Walton Beach, FL 32547-2301 |
Second Address | Destin, FL 32541-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |