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NPI Code Detail

MEDICARE: ANITA LYNN ABDULLAH OTR

MEDICARE: ANITA LYNN ABDULLAH OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT753FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00326423OTHERFLRR MEDICARE

General Provider Information

NPI Number : 1023013414
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA LYNN ABDULLAH OTR
Provider Business Mailing Address
First Line : 1325 SAN MARCO BLVD
Second Line : SUITE 200
City : JACKSONVILLE
State : FL
Zip : 32207-8568
Country : US
Telephone Number : 904-346-3465
Fax Number : 904-858-6489
Provider Business Practice Location Address
First Line : 1577 ROBERTS DR
Second Line : SUITE 320
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3264
Country : US
Telephone Number : 904-247-3324
Fax Number : 904-858-6489
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 03/17/2016

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Directions to “ ANITA LYNN ABDULLAH OTR” Practice Location

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