Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT13713 | FL |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 04748 | MD |
NPI | 1144432550 |
---|---|
Provider Name | Ms. Theresa Marie Devries |
First Address | Ocala, FL 34471-0741 |
Second Address | Ocala, FL 34471-0741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 15/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT13713 | LICENSE (01) | FL |