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General NPI Number Information
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NPI Number | 1538541248
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Entity Type | Individual
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Provider Name | BRUNETTE ST VICTOR
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Gender | Female
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 1170 SUSSEX DR APT 1103
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-5326
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Country | US
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Telephone | 954-708-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 1170 SUSSEX DR APT 1103
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-5326
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Country | US
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Telephone | 954-708-6311
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA3256
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 14229
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License Number State | FL
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