Provider Demographics
NPI:1659108926
Name:HAMM, CADEDRA L (OTA)
Entity type:Individual
Prefix:MISS
First Name:CADEDRA
Middle Name:L
Last Name:HAMM
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 5TH COURT
Mailing Address - Street 2:202
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6857
Mailing Address - Country:US
Mailing Address - Phone:772-621-0577
Mailing Address - Fax:
Practice Address - Street 1:13000 SW TRADITION PKWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2885
Practice Address - Country:US
Practice Address - Phone:772-241-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18531224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant