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General NPI Number Information
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NPI Number | 1679072094
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Entity Type | Individual
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Provider Name | RICHELLE ANNE VILLA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 408 NE 6TH ST UNIT 444
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-6410
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Country | US
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Telephone | 202-541-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 408 NE 6TH ST UNIT 444
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-6410
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Country | US
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Telephone | 571-276-7105
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT20021
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License Number State | FL
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