Provider Demographics
NPI:1255958260
Name:POQUETTE, JOHN J (COTA/L)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:POQUETTE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6216
Mailing Address - Country:US
Mailing Address - Phone:623-910-8930
Mailing Address - Fax:
Practice Address - Street 1:3891 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6216
Practice Address - Country:US
Practice Address - Phone:623-910-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16132224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0TA-16132OtherFL OTA LICENCE