Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT20171 | FL |
NPI | 1003460189 |
---|---|
Provider Name | Rachel Ashton Forrest |
First Address | Port St Joe, FL 32456-6041 |
Second Address | Port St Joe, FL 32456-6041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2019 |
Last Update Date | 28/07/2019 |