Healthcare Provider Details

I. General information

NPI: 1013212364
Provider Name (Legal Business Name): MRS. ANITA NAUTIYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 SUN N LAKE BLVD
SEBRING FL
33872-2110
US

IV. Provider business mailing address

4844 SUN N LAKE BLVD
SEBRING FL
33872-2110
US

V. Phone/Fax

Practice location:
  • Phone: 863-991-3895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT7199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: