Provider Demographics
NPI:1225762024
Name:EUGENE, BERNITA VONNETTE (COTA)
Entity Type:Individual
Prefix:MS
First Name:BERNITA
Middle Name:VONNETTE
Last Name:EUGENE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11232
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1232
Mailing Address - Country:US
Mailing Address - Phone:954-483-0460
Mailing Address - Fax:
Practice Address - Street 1:1223 SUWANEE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5918
Practice Address - Country:US
Practice Address - Phone:954-483-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18990224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant