Individual
JESSICA A DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 PENN ST, STE 12, MELBOURNE, FL 32901-2643
(321) 768-6800
(321) 768-6858
Mailing address
1800 PENN ST, STE 12, MELBOURNE, FL 32901-2643
(321) 768-6800
(321) 768-6858
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11802
FL
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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