Healthcare Provider Details

I. General information

NPI: 1356905657
Provider Name (Legal Business Name): KAREN LYNN GOLDWIRE MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 09/17/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 ADANSON ST
ORLANDO FL
32804-1331
US

IV. Provider business mailing address

2400 S HWY 27
CLERMONT FL
34711-6816
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone: 352-394-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number19877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: