Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | OT10618 | FL |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT18517 | FL |
NPI | 1003998808 |
---|---|
Provider Name | Ms. Elleri Wyatt Leblanc |
First Address | Winter Park, FL 32792-2244 |
Second Address | Winter Park, FL 32792-2244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8881916100 | (05) | FL |