Individual
LAWRENCE WAYNE FAULKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1908 FABIEN CIR, MELBOURNE, FL 32940-6781
(321) 300-2178
Mailing address
1908 FABIEN CIR, MELBOURNE, FL 32940-6781
(321) 300-2178
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
102994
TX
225X00000X
Occupational Therapist
Primary
OT19498
FL
Other
Enumeration date
09/16/2019
Last updated
12/12/2021
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