Healthcare Provider Details

I. General information

NPI: 1235172859
Provider Name (Legal Business Name): BARBARA ANNETTE DIVINCENZO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

IV. Provider business mailing address

911 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-3108
  • Fax: 386-736-3643
Mailing address:
  • Phone: 386-736-3108
  • Fax: 386-736-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 2674
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2674
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT 2674
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 2674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: