Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119001548 | VA |
N | 225XE0001X | Environmental Modification | 0119001548 | VA |
NPI | 1942507363 |
---|---|
Provider Name | Ms. Linda Bailey Bruce |
First Address | Midlothian, VA 23114-3074 |
Second Address | Orlando, FL 32817-8354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 21/02/2011 |