# IMAJICA MOTTLEY MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Imajica Mottley MEDICAL SUPPLY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225824857
- **Authorized official:** IMAJICA MOTTLEY (PRESIDENT)
- **Authorized official phone:** (813) 497-2959

## Contact information

- **Practice address:** 417 SILVER BEACH RD, LAKE PARK, FL 33403-3324
- **Practice address phone:** (813) 497-2959
- **Practice address fax:** (813) 592-6728
- **Mailing address:** 417 SILVER BEACH RD, LAKE PARK, FL 33403-3324
- **Mailing address phone:** (813) 497-2959
- **Mailing address fax:** (813) 592-6728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 04/18/2025
- **Last updated:** 04/18/2025