Individual
SANDRA LA O
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4800 N FEDERAL HWY STE 104, BOCA RATON, FL 33431-5188
(617) 470-9827
(561) 372-2651
Mailing address
1749 MANOR AVE, WEST PALM BEACH, FL 33409-5126
(561) 250-2397
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9553690912
—
FL
Enumeration date
10/27/2017
Last updated
10/27/2017
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