Individual
MRS. IZORA LAVERNE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 OAKPOINT CIR, DAVENPORT, FL 33837-8694
(863) 229-2764
(863) 229-2764
Mailing address
707 OAKPOINT CIR, DAVENPORT, FL 33837-8694
(863) 229-2764
(863) 229-2764
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
FL
Other
Enumeration date
10/06/2006
Last updated
07/09/2007
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