Provider Demographics
NPI:1134558778
Name:CARBONE, JUDY
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:CARBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:L
Other - Last Name:BUKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1856 SENEGAL DATE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3386
Mailing Address - Country:US
Mailing Address - Phone:239-593-7096
Mailing Address - Fax:
Practice Address - Street 1:1856 SENEGAL DATE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3386
Practice Address - Country:US
Practice Address - Phone:239-593-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA632224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant