Individual
BRIAN IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(813) 421-0697
Mailing address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
11254
NC
225X00000X
Occupational Therapist
Primary
OT19227
FL
Other
Enumeration date
10/19/2017
Last updated
05/16/2024
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