Individual
JESSE WHALEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
886 AACHEN AVE NW, PALM BAY, FL 32907-9342
(321) 768-2453
Mailing address
886 AACHEN AVE, PALM BAY, FL 32907
(321) 768-2453
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
Primary
307117
FL
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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