MEDICARE: EBONY TAMARA HODGE-FRANCIS OTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	13700	FL

General Provider Information

NPI Number	:	1831320308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY TAMARA HODGE-FRANCIS OTT

Provider Business Mailing Address
First Line	:	7370 STIRLING RD APT 105
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-1673
Country	:	US
Telephone Number	:	954-673-8932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 W 84TH ST STE 110
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-821-8889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2009
Last Update Date	:	08/02/2009

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