Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath |
NPI | 1063847135 |
---|---|
Provider Name | Ms. An Jalique C Ottley |
First Address | Fort Myers, FL 33905-4844 |
Second Address | Fort Myers, FL 33905-4844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |