Individual
JERRY ENNIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6406 21ST AVE W, BRADENTON, FL 34209-7850
(941) 798-8712
Mailing address
6406 21ST AVE W, BRADENTON, FL 34209-7850
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT11536
FL
Other
Enumeration date
01/14/2014
Last updated
01/14/2014
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