Individual
JACKIE FLORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2910 62ND ST W, BRADENTON, FL 34209-7045
(941) 704-3321
Mailing address
2910 62ND ST W, BRADENTON, FL 34209-7045
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA12383
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNK
I DONT HAVE ONE
—
Enumeration date
08/16/2012
Last updated
08/16/2012
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