Individual
MR. RYAN BARRY PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2059 W MARLIN RD, AVON PARK, FL 33825-9365
(863) 452-6751
Mailing address
2059 W MARLIN RD, AVON PARK, FL 33825-9365
(863) 452-6751
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 1678
CA
224Z00000X
Occupational Therapy Assistant
OTA 9663
FL
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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