Provider Demographics
NPI:1508612102
Name:VIRUET, JOANNA (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:VIRUET
Suffix:
Gender:F
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 1:3740 WESTMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1374
Mailing Address - Country:US
Mailing Address - Phone:954-470-0600
Mailing Address - Fax:
Practice Address - Street 1:3740 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1374
Practice Address - Country:US
Practice Address - Phone:954-470-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant