Healthcare Provider Details

I. General information

NPI: 1255249389
Provider Name (Legal Business Name): GRETCHEN BUYTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 AVENUE O NE
WINTER HAVEN FL
33881-2499
US

IV. Provider business mailing address

1511 SHERWOOD LAKES BLVD
LAKELAND FL
33809-6801
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-3103
  • Fax:
Mailing address:
  • Phone: 231-735-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT23637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: