Healthcare Provider Details

I. General information

NPI: 1689702664
Provider Name (Legal Business Name): VIVIAN DUPREY MS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S SEMORAN BLVD SUITE 300
ORLANDO FL
32822-2500
US

IV. Provider business mailing address

767 MEADOWSIDE CT
ORLANDO FL
32825-5776
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-0228
  • Fax: 407-281-0229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 10702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: