Provider Demographics
NPI:1013601079
Name:MOHORN, EBONEY LATOYA
Entity Type:Individual
Prefix:MS
First Name:EBONEY
Middle Name:LATOYA
Last Name:MOHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6128
Mailing Address - Country:US
Mailing Address - Phone:954-684-0640
Mailing Address - Fax:
Practice Address - Street 1:6260 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-6128
Practice Address - Country:US
Practice Address - Phone:954-684-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist