Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT19794 | FL |
NPI | 1003371469 |
---|---|
Provider Name | Summer Squillacioti |
First Address | Boynton Beach, FL 33426-7444 |
Second Address | Greenacres, FL 33467-2053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2019 |
Last Update Date | 15/09/2020 |