Healthcare Provider Details

I. General information

NPI: 1639435852
Provider Name (Legal Business Name): IRMA COUPET OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 PIAZZA DELLE PALLOTTOLE
BOYNTON BEACH FL
33426-8274
US

IV. Provider business mailing address

1302 PIAZZA DELLE PALLOTTOLE
BOYNTON BEACH FL
33426-8274
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-5170
  • Fax:
Mailing address:
  • Phone: 561-704-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT10146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: