Healthcare Provider Details

I. General information

NPI: 1346843091
Provider Name (Legal Business Name): DUDLEY YACINTHE OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 BERACASA WAY STE 102
BOCA RATON FL
33433-3453
US

IV. Provider business mailing address

PO BOX 8396
DELRAY BEACH FL
33482-8396
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-2033
  • Fax: 561-939-2037
Mailing address:
  • Phone: 561-939-2033
  • Fax: 561-939-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: