Individual
LC VAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
29 LINCOLN LN, PALM COAST, FL 32137-9555
(386) 793-0612
(386) 447-5281
Mailing address
31 OLD KINGS RD N, SUITE 1, PALM COAST, FL 32137-8257
(386) 793-0612
(386) 447-5281
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA195
FL
Other
Enumeration date
03/25/2009
Last updated
03/25/2009
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