MEDICARE: MRS. JIMMIE LYNETTE DEVAUGHN OTRL

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	OT10754	FL

General Provider Information

NPI Number	:	1871706846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIMMIE LYNETTE DEVAUGHN OTRL

Provider Business Mailing Address
First Line	:	5751 WESTVIEW DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-3940
Country	:	US
Telephone Number	:	407-517-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 WESTVIEW DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-3940
Country	:	US
Telephone Number	:	407-517-0740
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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