Healthcare Provider Details

I. General information

NPI: 1609029719
Provider Name (Legal Business Name): JOSEPH PAUL AUDETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15089 JAMAICA DR
WEST PALM BEACH FL
33410-1005
US

IV. Provider business mailing address

15089 JAMAICA DR
WEST PALM BEACH FL
33410-1005
US

V. Phone/Fax

Practice location:
  • Phone: 954-298-9241
  • Fax:
Mailing address:
  • Phone: 954-298-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMA20169
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA20169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: