Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT4376 | FL |
NPI | 1144356320 |
---|---|
Provider Name | Ms. Sally Elaine Thimm |
First Address | Venice, FL 34293-6835 |
Second Address | Venice, FL 34292-1642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 09/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E6809A | (02) | FL |