Healthcare Provider Details

I. General information

NPI: 1063874378
Provider Name (Legal Business Name): JEANNA GWAZDOSKY MOT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S BENEVA RD
SARASOTA FL
34232-2411
US

IV. Provider business mailing address

16415 62ND GLN E
PARRISH FL
34219-4319
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-0310
  • Fax:
Mailing address:
  • Phone: 941-544-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 17610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: