Provider Demographics
NPI:1689981938
Name:DAHL JACKSON, ROCHELLE LOTOYA (AS)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LOTOYA
Last Name:DAHL JACKSON
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 VIA DELRAY
Mailing Address - Street 2:UNIT 201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1356
Mailing Address - Country:US
Mailing Address - Phone:561-713-3329
Mailing Address - Fax:
Practice Address - Street 1:1905 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2127
Practice Address - Country:US
Practice Address - Phone:954-846-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant