Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT11455 | FL |
NPI | 1144596693 |
---|---|
Provider Name | Ritchie Tan |
First Address | Brooksville, FL 34604-5812 |
Second Address | Brooksville, FL 34604-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 29/03/2012 |