Individual
SAMANTHA WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
803 OAK ST, GREEN COVE SPRINGS, FL 32043-4317
(904) 284-5568
Mailing address
803 OAK ST, GREEN COVE SPRINGS, FL 32043-4317
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
13182
FL
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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