Individual
MS. DEVORA WHEELER PATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21490 NE 37TH PL, WILLISTON, FL 32696-7014
(352) 528-9442
Mailing address
21490 NE 37TH PL, WILLISTON, FL 32696-7014
(352) 528-9442
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
688535796
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
688535796
MEDICAID PROVIDER ID NUMBER
FL
Enumeration date
10/17/2010
Last updated
10/17/2010
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