Provider Demographics
NPI:1710300959
Name:CYRILLE, MEDGINE (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:MEDGINE
Middle Name:
Last Name:CYRILLE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:MEDGINE
Other - Middle Name:MICHELLE
Other - Last Name:CARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:33 ABBEY LN APT 202
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1740
Mailing Address - Country:US
Mailing Address - Phone:202-999-0161
Mailing Address - Fax:
Practice Address - Street 1:1200 FIRST ST NE, 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:305-842-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000886225X00000X
VA0119005868225X00000X
FLOT19662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist