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General NPI Number Information
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NPI Number | 1043465479
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Entity Type | Individual
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Provider Name | JOY DEBUSK OTA
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Gender | Female
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Dates
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Enumeration Date | 11/26/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 7201 GREENBORO DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1698
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Country | US
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Telephone | 321-821-6736
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Fax |
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Provider Business Mailing Address
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Address Line | 2674 TUSCARORA CT
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8091
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Country | US
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Telephone | 321-729-6580
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Fax |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OTA 10480
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License Number State | FL
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