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General NPI Number Information
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NPI Number | 1487300802
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Entity Type | Individual
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Provider Name | JESSICA MONIQUE GRAHAM OTA
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Gender | Female
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 15127 S JOG RD STE 210
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City | DELRAY BEACH
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State | FL
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Zip | 33446-1251
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Country | US
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Telephone | 561-498-1098
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Fax | 561-495-2524
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Provider Business Mailing Address
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Address Line | 1503 BELMONT PL
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7839
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Country | US
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Telephone | 850-284-8644
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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 | OTA14759
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License Number State | FL
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