Individual
JEROME TIMOTHY FOUNTAIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17670 NW 78TH AVE, HIALEAH, FL 33015-3664
(305) 512-5757
Mailing address
11650 NW 29TH MNR, SUNRISE, FL 33323-1649
(239) 867-1879
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA17452
FL
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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