Healthcare Provider Details

I. General information

NPI: 1295981207
Provider Name (Legal Business Name): MARY SENA PEDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 08/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 INTERNATIONAL PKWY
LAKE MARY FL
32746-5030
US

IV. Provider business mailing address

1432 MARTIN RD
ALBERT LEA MN
56007-1534
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 651-373-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010784
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: