Healthcare Provider Details

I. General information

NPI: 1649749532
Provider Name (Legal Business Name): MRS. JULIE ENAMORADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 BELLWETHER LN
OXFORD FL
34484-2980
US

IV. Provider business mailing address

8124 JOYCE LN
LAKELAND FL
33809-1501
US

V. Phone/Fax

Practice location:
  • Phone: 352-430-0076
  • Fax:
Mailing address:
  • Phone: 863-370-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA12063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: