Individual provider · NPI-1

Jacob Derocher, OTR/L

Occupational Therapist · Port Saint Lucie, FL

NPI number1689325052
StatusActive
Last updated in NPPESJan 17, 2022

Details

NPI
1689325052
Entity type
Individual (NPI-1)
Name
Jacob Derocher
Credential
OTR/L
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 17, 2022
Certification date
Jan 17, 2022
Last updated
Jan 17, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225X00000X Occupational Therapist22580FLYes

Practice location

5367 Nw Rugby Dr
Port Saint Lucie, FL 34983-3386

Phone 772-370-9628

Mailing address

5367 Nw Rugby Dr
Port Saint Lucie, FL 34983-3386

Phone 772-370-9628

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