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NPI Code Detail

MEDICARE: JACQUELYN BRADY HAIRE COTA/L CLT

MEDICARE: JACQUELYN BRADY HAIRE COTA/L CLT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA12498FL

General Provider Information

NPI Number : 1437691987
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN BRADY HAIRE COTA/L CLT
Provider Business Mailing Address
First Line : 787 37TH ST STE E100
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-7304
Country : US
Telephone Number : 772-569-9747
Fax Number : 772-569-9979
Provider Business Practice Location Address
First Line : 787 37TH ST STE E100
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-7304
Country : US
Telephone Number : 772-569-9747
Fax Number : 772-569-9979
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2016
Last Update Date : 11/15/2016

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Directions to “ JACQUELYN BRADY HAIRE COTA/L CLT” Practice Location

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