Provider Demographics
NPI:1831320308
Name:HODGE-FRANCIS, EBONY TAMARA (OTT)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:TAMARA
Last Name:HODGE-FRANCIS
Suffix:
Gender:F
Credentials:OTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 STIRLING RD APT 105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1673
Mailing Address - Country:US
Mailing Address - Phone:954-673-8932
Mailing Address - Fax:
Practice Address - Street 1:3412 W 84TH ST STE 110
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4918
Practice Address - Country:US
Practice Address - Phone:305-821-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist