Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1189 | FL |
NPI | 1003933151 |
---|---|
Provider Name | Willene Declere |
First Address | Kissimmee, FL 34744-5617 |
Second Address | Kissimmee, FL 34744-5617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |