Individual
BRENDA ROYSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
928 MAR WALT DRIVE, SUITE 104, FORT WALTON BEACH, FL 32547
(850) 863-4747
Mailing address
808 E LAKE DR, SHALIMAR, FL 32579-2249
(850) 863-4747
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT 1325
LICENSE #
FL
Enumeration date
08/20/2006
Last updated
07/08/2007
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