Healthcare Provider Details

I. General information

NPI: 1124130794
Provider Name (Legal Business Name): DAIL WOOTEN HOVEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RIDGEWOOD AVE
BRANDON FL
33510-4617
US

IV. Provider business mailing address

619 ORANGE VALLEY LN
LAKELAND FL
33813-2653
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-1060
  • Fax:
Mailing address:
  • Phone: 863-619-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT9723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: