Healthcare Provider Details

I. General information

NPI: 1528971306
Provider Name (Legal Business Name): LEROY WHITERS MOBLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 SW LEE AVE
MADISON FL
32340-1081
US

IV. Provider business mailing address

138 SW LEE AVE
MADISON FL
32340-1081
US

V. Phone/Fax

Practice location:
  • Phone: 850-464-8589
  • Fax:
Mailing address:
  • Phone: 850-464-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA18350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: