Individual
DALLES RAYDELL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15002 HUTCHISON RD, TAMPA, FL 33625-5502
(813) 960-1969
Mailing address
2294 PRIMROSE LN APT 1606, CLEARWATER, FL 33763-1059
(407) 731-7695
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
16690
FL
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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