Healthcare Provider Details

I. General information

NPI: 1356961270
Provider Name (Legal Business Name): HOLLY BOTTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 09/27/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HWY 27 STE B201
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

2481 THE OAKS BLVD
KISSIMMEE FL
34746-3892
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number20743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: