Individual
MAGDA JEROME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2511 N JOHN YOUNG PKWY, KISSIMMEE, FL 34741-1653
(321) 443-1333
Mailing address
2511 N JOHN YOUNG PKWY, KISSIMMEE, FL 34741-1653
(321) 443-1333
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA9789
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
888257600
—
FL
Enumeration date
03/27/2007
Last updated
02/15/2013
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