Organization
501 C OUTSOURCE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN E FOSS ITDS (PRESIDENT)
(239) 543-5856
Entity
Organization
Contact information
Practice address
15397 MOONRAKER CT APT 603, NORTH FORT MYERS, FL 33917-3100
(239) 543-5856
(239) 543-5856
Mailing address
15397 MOONRAKER CT APT 603, NORTH FORT MYERS, FL 33917-3100
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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