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General NPI Number Information
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NPI Number | 1003849696
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Entity Type | Individual
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Provider Name | JACQUELYN DAWN FLOYD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 GATEWAY BLVD UNIT 309
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City | GREENVILLE
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State | SC
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Zip | 29607-5856
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Country | US
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Telephone | 864-918-2711
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Fax | 678-840-2112
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-0369
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Country | US
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Telephone | 864-201-4301
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Fax | 678-840-2112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State | SC
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