Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA15330 | FL |
NPI | 1023562923 |
---|---|
Provider Name | Tara Combs |
First Address | South Daytona, FL 32119-1934 |
Second Address | South Daytona, FL 32119-3168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 22/04/2020 |