| NPI | 1982160412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JO THORN Executive Director 386-247-4736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 224Z00000X Occupational Therapy Assistant | |
| 225X00000X Occupational Therapist | |
| 251S00000X | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-08-01 |