Healthcare Provider Details

I. General information

NPI: 1093985277
Provider Name (Legal Business Name): JACQUELINE MEKDECI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 S DIXIE HWY STE 205
MIAMI FL
33156-5955
US

IV. Provider business mailing address

12651 S DIXIE HWY STE 205
MIAMI FL
33156-5955
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-9222
  • Fax: 305-232-8808
Mailing address:
  • Phone: 305-232-9222
  • Fax: 305-232-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: