Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 17423 | FL |
NPI | 1023667128 |
---|---|
Provider Name | Tania L Montanez Benitez |
First Address | Orlando, FL 32825-3371 |
Second Address | Orlando, FL 32809-5734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |