Healthcare Provider Details

I. General information

NPI: 1881145001
Provider Name (Legal Business Name): JAMES FRANTZ OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 MACK BAYOU LOOP
SANTA ROSA BEACH FL
32459-7198
US

IV. Provider business mailing address

PO BOX 931306
ATLANTA GA
31193-1306
US

V. Phone/Fax

Practice location:
  • Phone: 850-622-0842
  • Fax:
Mailing address:
  • Phone: 678-459-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT16414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: