Provider Demographics
NPI:1831688506
Name:VALENTINE, LATRICIA DENISE (OT)
Entity type:Individual
Prefix:
First Name:LATRICIA
Middle Name:DENISE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 LAFAYETTE ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-1248
Mailing Address - Country:US
Mailing Address - Phone:321-508-7787
Mailing Address - Fax:
Practice Address - Street 1:4150 INDIAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-7224
Practice Address - Country:US
Practice Address - Phone:772-254-4618
Practice Address - Fax:772-252-4693
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist