Individual
LIANA RASCHKE VALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4650 STATE ROAD 16, ST AUGUSTINE, FL 32092-0600
(904) 940-2193
Mailing address
1199 SAN JOSE FOREST DR, ST AUGUSTINE, FL 32080-5412
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
8444
FL
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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