Provider Demographics
NPI:1871706846
Name:DEVAUGHN, JIMMIE LYNETTE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JIMMIE
Middle Name:LYNETTE
Last Name:DEVAUGHN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:JIMMIE
Other - Middle Name:LYNETTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:5751 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-3940
Mailing Address - Country:US
Mailing Address - Phone:407-517-0740
Mailing Address - Fax:
Practice Address - Street 1:5751 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-3940
Practice Address - Country:US
Practice Address - Phone:407-517-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10754225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist