Individual
DETRISH SPEED ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 BRISTOL DR, COCOA, FL 32922-6710
(321) 403-3998
Mailing address
1050 BRISTOL DR, COCOA, FL 32922-6710
(321) 403-3998
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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