Healthcare Provider Details

I. General information

NPI: 1194928085
Provider Name (Legal Business Name): JESSICA LYN PIOTRACZK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

IV. Provider business mailing address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-2862
  • Fax: 352-394-2861
Mailing address:
  • Phone: 352-394-2862
  • Fax: 352-394-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: