Individual
KENNETH FULLER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 S BEVERLY ST, PERRY, FL 32348-5122
(850) 295-5314
Mailing address
106 S BEVERLY ST, PERRY, FL 32348-5122
(850) 295-5314
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 13652
FL
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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