| NPI | 1306107099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA DONALDSON Administrator 904-376-3707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-03-03 |