Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT18043 | FL |
N | 225X00000X | Occupational Therapist | OT3271 | MS |
NPI | 1003350125 |
---|---|
Provider Name | Ulysses Monroe |
First Address | Jacksonville, FL 32218-2357 |
Second Address | Plymouth, MI 48170-1694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2016 |
Last Update Date | 08/12/2016 |