Healthcare Provider Details

I. General information

NPI: 1205962198
Provider Name (Legal Business Name): JAMES FORTIER OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 SW 3RD AVE
OCALA FL
34474-4228
US

IV. Provider business mailing address

5467 SE 44TH CIR
OCALA FL
34480-4928
US

V. Phone/Fax

Practice location:
  • Phone: 352-804-8701
  • Fax:
Mailing address:
  • Phone: 352-804-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 10777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: