Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT15704 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | OT005648 | GA |
NPI | 1740612480 |
---|---|
Provider Name | Ms. Lily Yarbrough Condy |
First Address | Jacksonville, FL 32207-8568 |
Second Address | Jacksonville, FL 32207-8568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2013 |
Last Update Date | 02/09/2015 |