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General NPI Number Information
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NPI Number | 1962921171
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Entity Type | Individual
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Provider Name | BRIAN MICK
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Gender | Male
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 777 9TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-8135
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Country | US
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Telephone | 239-261-8126
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Fax |
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Provider Business Mailing Address
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Address Line | 297 MILLSTONE RD
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City | MILLSTONE TOWNSHIP
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State | NJ
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Zip | 08535-1215
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Country | US
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Telephone | 908-770-8789
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT19338
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License Number State | FL
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