Provider Demographics
NPI:1548568348
Name:JONES, VIVIAN LEE
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:LEE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OCCUPATIONAL THERAPY
Mailing Address - Street 1:19238 COUNTY ROAD 49
Mailing Address - Street 2:
Mailing Address - City:OBRIEN
Mailing Address - State:FL
Mailing Address - Zip Code:32071
Mailing Address - Country:US
Mailing Address - Phone:386-292-3262
Mailing Address - Fax:
Practice Address - Street 1:19238 COUNTY ROAD 49
Practice Address - Street 2:
Practice Address - City:O BRIEN
Practice Address - State:FL
Practice Address - Zip Code:32071-3426
Practice Address - Country:US
Practice Address - Phone:386-292-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA8023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist