Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 22295 | FL |
NPI | 1023789336 |
---|---|
Provider Name | Sanja Dizdarevic |
First Address | Cape Coral, FL 33991-3142 |
Second Address | Weston, FL 33331-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2021 |
Last Update Date | 26/09/2021 |