Healthcare Provider Details

I. General information

NPI: 1871584854
Provider Name (Legal Business Name): DANA PADGETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 NE 154TH ST
STARKE FL
32091-6418
US

IV. Provider business mailing address

2162 NE 154TH ST
STARKE FL
32091-6418
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-4464
  • Fax: 904-964-4279
Mailing address:
  • Phone: 904-964-4464
  • Fax: 904-964-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 8454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: