Individual
MRS. MISTY DAWN WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A. DEGREE
Contact information
Practice address
21263 33RD RD, LAKE CITY, FL 32024-2431
(386) 628-1419
Mailing address
21263 33RD RD, LAKE CITY, FL 32024-2431
(386) 628-1419
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/26/2013
Last updated
02/26/2013
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