Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | NONE | FL |
NPI | 1487085015 |
---|---|
Provider Name | Terry Ward |
First Address | Tallahassee, FL 32301-5701 |
Second Address | Tallahassee, FL 32301-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2013 |
Last Update Date | 08/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
686873879 | (05) | FL |
686873896 | (05) | FL |
686873898 | (05) | FL |