Provider Demographics
NPI:1700181534
Name:HRACHO, MYKIM
Entity type:Individual
Prefix:
First Name:MYKIM
Middle Name:
Last Name:HRACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYKIM
Other - Middle Name:
Other - Last Name:MARCHICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:863 N COCOA BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7510
Mailing Address - Country:US
Mailing Address - Phone:321-305-5965
Mailing Address - Fax:321-305-5965
Practice Address - Street 1:863 N COCOA BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7510
Practice Address - Country:US
Practice Address - Phone:321-305-5965
Practice Address - Fax:321-305-5965
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist