Provider Demographics
NPI:1659746998
Name:MOTEN, RHODA
Entity type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:MOTEN
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 1:2090 S NOVA RD STE A127
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8841
Mailing Address - Country:US
Mailing Address - Phone:386-453-4909
Mailing Address - Fax:
Practice Address - Street 1:337 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2158
Practice Address - Country:US
Practice Address - Phone:386-453-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1310178174400000X
FLCL0238165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist