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General NPI Number Information
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NPI Number | 1518490820
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Entity Type | Organization
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Legal Business Name | LIFESPAN PRACTICE, LLC
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 37933 FLORIDA AVE
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City | DADE CITY
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State | FL
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Zip | 33525-4910
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Country | US
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Telephone | 813-312-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 37933 FLORIDA AVE
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City | DADE CITY
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State | FL
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Zip | 33525-4910
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Country | US
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Telephone | 813-312-5716
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OCCUPATIONAL THERAPY
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Name | DR. MEGAN NICOLE DADEZ
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Credential | OTD, OTR/L
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Telephone | 813-312-5716
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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 | OT18332
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License Number State | FL
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