Individual
DIANNE JANELLE SEERATTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9355 SAN JOSE BLVD, JACKSONVILLE, FL 32257-5503
(904) 739-6680
Mailing address
4263 LOSCO RD APT 716, JACKSONVILLE, FL 32257-1451
(904) 258-5661
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15111
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S635170785010
DRIVERS LICENSE
FL
Enumeration date
09/20/2018
Last updated
09/20/2018
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