Provider Demographics
NPI:1699556506
Name:OATES, D'ERICA DIONE (CRANIAL PROTHESIS)
Entity type:Individual
Prefix:
First Name:D'ERICA
Middle Name:DIONE
Last Name:OATES
Suffix:
Gender:F
Credentials:CRANIAL PROTHESIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 CRANBERRY ISLES WAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2144
Mailing Address - Country:US
Mailing Address - Phone:407-508-0377
Mailing Address - Fax:
Practice Address - Street 1:1022 W SR 436 STE 1000
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-2919
Practice Address - Country:US
Practice Address - Phone:689-227-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLK0NUM2LGWU335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier