Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 10404 | FL |
NPI | 1043373228 |
---|---|
Provider Name | Shannon Visentin |
First Address | Boca Raton, FL 33486-8449 |
Second Address | Boca Raton, FL 33486-8449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |