Healthcare Provider Details

I. General information

NPI: 1255540407
Provider Name (Legal Business Name): MARSHA L WOLL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CHRIS CT
SAINT CLOUD FL
34769-5221
US

IV. Provider business mailing address

PO BOX 700223
SAINT CLOUD FL
34770-0223
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-0694
  • Fax:
Mailing address:
  • Phone: 407-891-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA27762
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: