Provider Demographics
NPI:1952980583
Name:LUMMER, NYLAH DARLENE (ORT/L)
Entity Type:Individual
Prefix:
First Name:NYLAH
Middle Name:DARLENE
Last Name:LUMMER
Suffix:
Gender:F
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 S OCEAN DR APT 16C
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5969
Mailing Address - Country:US
Mailing Address - Phone:707-486-2523
Mailing Address - Fax:
Practice Address - Street 1:520 NW 165TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6343
Practice Address - Country:US
Practice Address - Phone:786-623-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL21733225X00000X, 225XP0200X
CA17497225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist