Provider Demographics
NPI:1497387658
Name:MORESTANT, MARIEKED
Entity type:Individual
Prefix:
First Name:MARIEKED
Middle Name:
Last Name:MORESTANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 SW 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4237
Mailing Address - Country:US
Mailing Address - Phone:352-233-0869
Mailing Address - Fax:
Practice Address - Street 1:10910 SW 41ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4237
Practice Address - Country:US
Practice Address - Phone:352-233-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities