Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA000622 | FL |
NPI | 1023335809 |
---|---|
Provider Name | Ms. Sherry Whidden |
First Address | Madill, OK 73446-1200 |
Second Address | Tampa, FL 33613-1367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 03/05/2010 |