Provider Demographics
NPI:1922856459
Name:BADONE, MIA DOMINIQUE (MSOT)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:DOMINIQUE
Last Name:BADONE
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 MAIN ST APT 3054
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5358
Mailing Address - Country:US
Mailing Address - Phone:561-354-8575
Mailing Address - Fax:
Practice Address - Street 1:4424 MAIN ST APT 3054
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5358
Practice Address - Country:US
Practice Address - Phone:561-354-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist