Healthcare Provider Details

I. General information

NPI: 1457712390
Provider Name (Legal Business Name): JULIANNE THERESA RAYMOND OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD #129
ORLANDO FL
32825-4458
US

IV. Provider business mailing address

940 W CANTON AVE APT A420
WINTER PARK FL
32789-3076
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 407-451-7561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: