Healthcare Provider Details

I. General information

NPI: 1013195676
Provider Name (Legal Business Name): DESIREE CAROLINA HARDWICK OTR/L; NTMTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 SPRING HILL DR
SPRING HILL FL
34609-5009
US

IV. Provider business mailing address

13163 HAVERHILL DR
SPRING HILL FL
34609-0643
US

V. Phone/Fax

Practice location:
  • Phone: 352-559-9500
  • Fax: 352-559-0585
Mailing address:
  • Phone: 915-253-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT19354
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 007043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: