Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1134657786 |
---|---|
Provider Name | Philip O'connor |
First Address | Jacksonville, FL 32257-3726 |
Second Address | Jacksonville, FL 32257-3726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 25/04/2019 |