Individual
GRACE MARIE BANQUICIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3050 WOODMONT AVE, WINTER HAVEN, FL 33884-3800
(863) 324-7300
Mailing address
1601 GAINES MILL CT APT 203, CELEBRATION, FL 34747-5188
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
12/03/2017
Last updated
12/03/2017
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