Healthcare Provider Details

I. General information

NPI: 1073432746
Provider Name (Legal Business Name): PHARRAH N JEAN-LOUIS CNA,COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 SW PLYMOUTH ST
PORT SAINT LUCIE FL
34953-2380
US

IV. Provider business mailing address

2216 CONWAY CIR
SUMMERVILLE SC
29486-8111
US

V. Phone/Fax

Practice location:
  • Phone: 772-626-6903
  • Fax:
Mailing address:
  • Phone: 772-626-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA19469
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: