Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 000620-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 000620-1 | NY |
NPI | 1154647873 |
---|---|
Provider Name | Ms. Willinda Truitt-Brown |
First Address | Palm Coast, FL 32135-3764 |
Second Address | Palm Coast, FL 32137-9127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 23/09/2013 |