Healthcare Provider Details

I. General information

NPI: 1699725887
Provider Name (Legal Business Name): YACAVONE HOME THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 STREAM DR
MELBOURNE FL
32940
US

IV. Provider business mailing address

3773 STREAM DR
MELBOURNE FL
32940-1102
US

V. Phone/Fax

Practice location:
  • Phone: 212-468-9393
  • Fax: 321-246-8939
Mailing address:
  • Phone: 212-468-9393
  • Fax: 321-246-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10000
License Number StateFL

VIII. Authorized Official

Name: MRS. JENNIFER LEE FITZGERALD
Title or Position: OWNER/PRESIDENT
Credential: MOT, OTR, LMT
Phone: 321-246-8939