Healthcare Provider Details

I. General information

NPI: 1912915588
Provider Name (Legal Business Name): VALERIE FAUL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ORTHOPAEDIC PL
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

1 ORTHOPAEDIC PL
SAINT AUGUSTINE FL
32086-4202
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-825-2490
Mailing address:
  • Phone: 904-825-0540
  • Fax: 904-825-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: