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General NPI Number Information
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NPI Number | 1285753053
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Entity Type | Individual
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Provider Name | ERIC MICHAEL SNOWBALL OTRL
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4240 LAKELAND HIGHLANDS RD
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City | LAKELAND
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State | FL
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Zip | 33813-3113
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Country | US
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Telephone | 863-607-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 5655 SUMMERLAND HILLS CIRCLE
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City | LAKELAND
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State | FL
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Zip | 33812-6366
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Country | US
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Telephone | 863-619-2298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 4485
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License Number State | FL
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