Healthcare Provider Details

I. General information

NPI: 1982975223
Provider Name (Legal Business Name): TERI JEAN FORKEY II OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

19196 CYPRESS VIEW DR
FORT MYERS FL
33967-4825
US

V. Phone/Fax

Practice location:
  • Phone: 239-242-8473
  • Fax:
Mailing address:
  • Phone: 919-282-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT14957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: