Healthcare Provider Details

I. General information

NPI: 1225366842
Provider Name (Legal Business Name): THELMA AILEEN EPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WILMINGTON ST
OPA LOCKA FL
33054-3760
US

IV. Provider business mailing address

1801 WILMINGTON ST
OPA LOCKA FL
33054-3760
US

V. Phone/Fax

Practice location:
  • Phone: 786-317-8273
  • Fax:
Mailing address:
  • Phone: 786-317-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: