Healthcare Provider Details

I. General information

NPI: 1760019392
Provider Name (Legal Business Name): JESSICA L YAUCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S FLORIDA AVE
DELAND FL
32720-5832
US

IV. Provider business mailing address

17269 SE 260TH AVENUE RD
UMATILLA FL
32784-8247
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-3481
  • Fax:
Mailing address:
  • Phone: 386-562-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberOT20703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: