Healthcare Provider Details

I. General information

NPI: 1841591443
Provider Name (Legal Business Name): PUTTENTIAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 WINTER GARDEN VINELAND RD STE 112
WINTER GARDEN FL
34787-4449
US

IV. Provider business mailing address

1222 WINTER GARDEN VINELAND RD STE 112
WINTER GARDEN FL
34787-4449
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-0029
  • Fax: 407-358-5207
Mailing address:
  • Phone: 954-594-2822
  • Fax: 407-358-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARITY HIGGINS
Title or Position: OWNER
Credential: M.O.T., OTR/L
Phone: 954-594-2822