Healthcare Provider Details

I. General information

NPI: 1396674941
Provider Name (Legal Business Name): WILLIAM MICHAEL DEVOE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 JIMMY BUFFETT MEM HWY
IND HBR BCH FL
32937
US

IV. Provider business mailing address

1370 TRADITION CIR APT 101
MELBOURNE FL
32901-3058
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-8989
  • Fax:
Mailing address:
  • Phone: 480-406-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA20570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: