Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA32767 | FL |
Y | 225X00000X | Occupational Therapist | OT9352 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | OT9352 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT9352 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT9352 | FL |
NPI | 1396076352 |
---|---|
Provider Name | Ms. Melinda C Broadstone |
First Address | Fort Walton Beach, FL 32549-2472 |
Second Address | Fort Walton Beach, FL 32548-5170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 14/01/2010 |