Provider Demographics
NPI:1477954071
Name:LAFORTUNE, PHOEBEE (COTA)
Entity Type:Individual
Prefix:MS
First Name:PHOEBEE
Middle Name:
Last Name:LAFORTUNE
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 1:2401 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4806
Mailing Address - Country:US
Mailing Address - Phone:954-786-6096
Mailing Address - Fax:954-786-6097
Practice Address - Street 1:2401 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4806
Practice Address - Country:US
Practice Address - Phone:954-786-6096
Practice Address - Fax:954-786-6097
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10987224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant