Healthcare Provider Details

I. General information

NPI: 1871804682
Provider Name (Legal Business Name): ANTONETTE MAGNATTA MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL PKWY STE 300
LAKE MARY FL
32746-5061
US

IV. Provider business mailing address

1436 2ND ST
EUREKA CA
95501-0602
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 313-506-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007736
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: