Healthcare Provider Details

I. General information

NPI: 1033564182
Provider Name (Legal Business Name): ANDREA DAGGETT MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 MEDICAL BLVD SUITE 200
NAPLES FL
34110-1413
US

IV. Provider business mailing address

7718 JEWEL LN 204
NAPLES FL
34109-8766
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-5799
  • Fax:
Mailing address:
  • Phone: 239-293-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 6597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: