Healthcare Provider Details

I. General information

NPI: 1811463151
Provider Name (Legal Business Name): REBECA TWARDY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14031 EYLEWOOD DR
WINTER GARDEN FL
34787-4662
US

IV. Provider business mailing address

14031 EYLEWOOD DR
WINTER GARDEN FL
34787-4662
US

V. Phone/Fax

Practice location:
  • Phone: 631-806-5621
  • Fax:
Mailing address:
  • Phone: 631-806-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: