Healthcare Provider Details

I. General information

NPI: 1861355612
Provider Name (Legal Business Name): MAGGIE DEMETROS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 53RD AVE W APT 218
BRADENTON FL
34210-3445
US

IV. Provider business mailing address

4108 53RD AVE W APT 218
BRADENTON FL
34210-3445
US

V. Phone/Fax

Practice location:
  • Phone: 207-450-2907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberO22747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: