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General NPI Number Information
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NPI Number | 1568872935
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Entity Type | Organization
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Legal Business Name | JODI DALE INC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 4691 MANDERLY DR
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City | WELLINGTON
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State | FL
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Zip | 33449-7406
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Country | US
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Telephone | 561-676-5198
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Fax | 954-343-6379
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Provider Business Mailing Address
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Address Line | 4691 MANDERLY DR
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City | WELLINGTON
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State | FL
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Zip | 33449-7406
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Country | US
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Telephone | 561-676-5198
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Fax | 954-343-6379
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Authorized Official
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Title or Position | PRES
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Name | JODI BRUNSVOLD
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Credential |
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Telephone | 561-676-5198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | OT0697
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License Number State | FL
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