Provider Demographics
NPI:1255767281
Name:JAMES, TRUDYANN ANGELLA (OT)
Entity type:Individual
Prefix:MRS
First Name:TRUDYANN
Middle Name:ANGELLA
Last Name:JAMES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SW 109TH AVE
Mailing Address - Street 2:APT. 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7114
Mailing Address - Country:US
Mailing Address - Phone:954-443-1746
Mailing Address - Fax:
Practice Address - Street 1:601 SW 109TH AVE
Practice Address - Street 2:APT. 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-7114
Practice Address - Country:US
Practice Address - Phone:954-443-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist