Individual
EBONY DACRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4704 ROCKVALE DR, KISSIMMEE, FL 34758-3360
(506) 861-1199
Mailing address
4704 ROCKVALE DR, KISSIMMEE, FL 34758-3360
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
OT19899
FL
225X00000X
Occupational Therapist
Primary
17004
NC
225X00000X
Occupational Therapist
OT19899
FL
Other
Enumeration date
03/11/2019
Last updated
12/06/2024
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