Individual
DEVIKA JIBODH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1934 TUMBLEWATER BLVD, OCOEE, FL 34761-3349
(407) 766-0616
Mailing address
1934 TUMBLEWATER BLVD, OCOEE, FL 34761-3349
(407) 766-0616
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15066
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA15066
COTA LICENSE
FL
Enumeration date
07/01/2016
Last updated
07/01/2016
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