| NPI | 1942858220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLEE GAMBOA Owner 904-753-5398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2021-01-03 |