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General NPI Number Information
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NPI Number | 1932753472
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Entity Type | Individual
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Provider Name | ADELINE BROOKE WARREN
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 512 S 11TH STREET
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City | LAKE WALES
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State | FL
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Zip | 33853
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Country | US
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Telephone | 863-676-8592
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Fax |
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Provider Business Mailing Address
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Address Line | 4022 ARIVA LANE APT 303
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City | LAKELAND
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State | FL
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Zip | 33812
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Country | US
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Telephone | 863-393-8030
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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 |
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License Number State |
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