Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 13531 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | OT 13531 | FL |
N | 225XM0800X | Mental Health | OT13531 | FL |
NPI | 1649413402 |
---|---|
Provider Name | Ms. Joanne Marie Leary |
First Address | Ave Maria, FL 34142-9596 |
Second Address | Ave Maria, FL 34142-9596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 27/06/2013 |