Provider Demographics
NPI:1114500535
Name:YOON, GRACE (OTD)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:YOON
Suffix:
Gender:
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 VIA BELLA
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1971
Mailing Address - Country:US
Mailing Address - Phone:954-594-3061
Mailing Address - Fax:
Practice Address - Street 1:10151 ENTERPRISE CTR STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3760
Practice Address - Country:US
Practice Address - Phone:954-688-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22084225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist