Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT 3619 | FL |
NPI | 1992834303 |
---|---|
Provider Name | Ms. Irma H M Witbreuk |
First Address | St Petersburg, FL 33703-3802 |
Second Address | St Petersburg, FL 33703-3802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT3619 | LICENSE (01) | |
Z04HP | BCBS OF FLORIDA (01) |