Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 8840 | FL |
NPI | 1033237094 |
---|---|
Provider Name | Stacey Hallett |
First Address | Maitland, FL 32751-4423 |
Second Address | Maitland, FL 32751-4423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |