Healthcare Provider Details

I. General information

NPI: 1912677212
Provider Name (Legal Business Name): MARCIA KANANI MCDOWELL LOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 SOLUTIONS WAY STE 100
ROCKLEDGE FL
32955-3623
US

IV. Provider business mailing address

590 SOLUTIONS WAY STE 100
ROCKLEDGE FL
32955-3623
US

V. Phone/Fax

Practice location:
  • Phone: 321-877-4732
  • Fax: 321-877-4735
Mailing address:
  • Phone: 321-877-4732
  • Fax: 321-877-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberORF292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: