Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | WV |
NPI | 1013228378 |
---|---|
Provider Name | Samantha Bean |
First Address | Jacksonville, FL 32216-8043 |
Second Address | Jacksonville, FL 32216-8043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02038530000 | (05) | WV |