Healthcare Provider Details

I. General information

NPI: 1770722472
Provider Name (Legal Business Name): CATHERINE A. VALENTINO DOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 ORTEGA ST
NAVARRE FL
32566-4111
US

IV. Provider business mailing address

1153 GULF BREEZE PKWY
GULF BREEZE FL
32561-7807
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-8919
  • Fax: 850-936-8936
Mailing address:
  • Phone: 850-932-6382
  • Fax: 850-932-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: