Healthcare Provider Details

I. General information

NPI: 1497901870
Provider Name (Legal Business Name): ROY FRANK SULMA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2008
Last Update Date: 08/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N HABANA AVE STE 22
TAMPA FL
33614-7123
US

IV. Provider business mailing address

4600 N HABANA AVE STE 22
TAMPA FL
33614-7123
US

V. Phone/Fax

Practice location:
  • Phone: 813-866-4426
  • Fax: 813-972-8866
Mailing address:
  • Phone: 813-866-4426
  • Fax: 813-972-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT6155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: