Provider Demographics
NPI:1376203638
Name:DUFFY, JOHN EDMUND (OT/L, CHT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDMUND
Last Name:DUFFY
Suffix:
Gender:M
Credentials:OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4736
Mailing Address - Country:US
Mailing Address - Phone:305-979-3305
Mailing Address - Fax:
Practice Address - Street 1:4711 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4736
Practice Address - Country:US
Practice Address - Phone:305-979-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty