Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT15909 | FL |
NPI | 1710313721 |
---|---|
Provider Name | Ms. Amy Lynn Grahn |
First Address | Cape Coral, FL 33991-2031 |
Second Address | Cape Coral, FL 33991-2031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |