Healthcare Provider Details

I. General information

NPI: 1962082651
Provider Name (Legal Business Name): LEMESE OLIVIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8103
US

IV. Provider business mailing address

6130 SHERWOOD GLEN WAY APT 3
WEST PALM BEACH FL
33415-6979
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-9996
  • Fax:
Mailing address:
  • Phone: 561-319-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-154923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: