Jerome Timothy Fountain III

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA17452 Issued in FL

Practice address

17670 NW 78TH Ave
Hialeah, FL 33015-3664

Phone

(305) 512-5757

NPI assigned

Sep 20, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1952952087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11650 NW 29TH MNR",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333231649",
            "telephone_number": "239-867-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17670 NW 78TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330153664",
            "telephone_number": "305-512-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "JEROME",
        "middle_name": "TIMOTHY",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA17452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primitivo Fortun Plane, APRN
• Idalmis Fortunato- Almaguer
• Irene Fortunato
• Pedro Barbaro Foster Toledo, MEDICAL DOCTOR
• Marta Martin Foster, MD
• Four Forty West Medical & Surgical Center Corp
• Dayanis Fourcoy Monterrey
• Thalia Fraga Fitte
• Fraga Pediatrics & Associates, P.a.
• Cristian Stephan Franceschi Torres, CRNA

• Occupational Therapy Assistant in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.