Provider Demographics
NPI:1811356785
Name:MA, VICKI SIU-YIN
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:SIU-YIN
Last Name:MA
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 1:84 PINNACLES DR
Mailing Address - Street 2:BUILDING A, SUITE 300
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2324
Mailing Address - Country:US
Mailing Address - Phone:386-447-7824
Mailing Address - Fax:
Practice Address - Street 1:84 PINNACLES DR
Practice Address - Street 2:BUILDING A, SUITE 300
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2324
Practice Address - Country:US
Practice Address - Phone:386-447-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist