Basic Information
Provider Information
NPI: 1568884450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIPAOLA
FirstName: JANET
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5180 FORMOSA CIRCLE
Address2:  
City: VERO BEACH
State: FL
PostalCode: 32967
CountryCode: US
TelephoneNumber: 2039474193
FaxNumber:  
Practice Location
Address1: 4301 N. FEDERAL HIGHWAY
Address2: SUITE 2 SOUTH
City: POMPANO
State: FL
PostalCode: 33064
CountryCode: US
TelephoneNumber: 8888809270
FaxNumber: 9543420273
Other Information
ProviderEnumerationDate: 01/10/2014
LastUpdateDate: 01/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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