Individual
MS. AGNES EGNISABAN DELOS SANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3040 N WICKHAM RD, SUITE 7, MELBOURNE, FL 32935-2369
(321) 255-9546
(321) 255-4690
Mailing address
3040 N WICKHAM RD, SUITE 7, MELBOURNE, FL 32935-2369
(321) 255-9546
(321) 255-4690
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 10582
FL
Other
Enumeration date
08/18/2005
Last updated
07/08/2007
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