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General NPI Number Information
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NPI Number | 1154992865
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Entity Type | Individual
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Provider Name | MEDINE MAUVAIS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2021
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Last Update Date | 07/03/2021
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Provider Practice Location Address
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Address Line | 6 N EUSTIS ST
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City | EUSTIS
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State | FL
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Zip | 32726-3408
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Country | US
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Telephone | 321-276-5054
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Fax |
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Provider Business Mailing Address
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Address Line | 158 LAUREL RIDGE AVE
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City | OCOEE
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State | FL
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Zip | 34761-1719
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Country | US
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Telephone | 321-999-5460
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 22042
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License Number State | FL
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