Provider Demographics
NPI:1396287165
Name:CADICHON, KERVIN
Entity type:Individual
Prefix:
First Name:KERVIN
Middle Name:
Last Name:CADICHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 PIERCE ST
Mailing Address - Street 2:4
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4698
Mailing Address - Country:US
Mailing Address - Phone:718-669-2701
Mailing Address - Fax:
Practice Address - Street 1:1728 PIERCE ST
Practice Address - Street 2:4
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4698
Practice Address - Country:US
Practice Address - Phone:718-669-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13052224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant