Individual
JUNIOR FORMUKONG MBIPEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3500 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-4101
(610) 359-4400
Mailing address
110 NORTHWEST 135TH WAY, BLDG. 46 APT 301, PLANTATION, FL 33325
(214) 986-0857
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18734
FL
Other
Enumeration date
02/17/2022
Last updated
04/30/2024
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