Provider Demographics
NPI:1578935755
Name:MUMLEY, JOANNE (MDIV, COTA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:MUMLEY
Suffix:
Gender:F
Credentials:MDIV, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-2014
Mailing Address - Country:US
Mailing Address - Phone:904-994-9933
Mailing Address - Fax:
Practice Address - Street 1:6 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2014
Practice Address - Country:US
Practice Address - Phone:904-994-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 514224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant