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General NPI Number Information
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NPI Number | 1326613589
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Entity Type | Individual
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Provider Name | VICTORIA MICHELE DEWATERS
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Gender | Female
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 8790 53RD WAY N
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City | PINELLAS PARK
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State | FL
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Zip | 33782-5180
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Country | US
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Telephone | 727-804-1442
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Fax | 727-491-5508
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | PINELLAS PARK
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State | FL
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Zip | 33780-0101
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Country | US
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Telephone | 727-804-1442
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Fax | 727-491-5508
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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