Healthcare Provider Details

I. General information

NPI: 1386935823
Provider Name (Legal Business Name): DOREEN GERENA MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 TOWN LOOP BLVD STE 300
ORLANDO FL
32837-6106
US

IV. Provider business mailing address

1115 NAJAC LN
KISSIMMEE FL
34759-7029
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-6285
  • Fax:
Mailing address:
  • Phone: 917-202-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number013600-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: