Basic Information
| Provider Information | |||||||||
| NPI: | 1952980583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUMMER | ||||||||
| FirstName: | NYLAH | ||||||||
| MiddleName: | DARLENE | ||||||||
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| Credential: | ORT/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1912 S OCEAN DR APT 16C | ||||||||
| Address2: | |||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330095969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074862523 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 NW 165TH ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866234053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2021 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 21733 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 17497 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | 17497 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225XP0200X | 21733 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.