Healthcare Provider Details

I. General information

NPI: 1801062294
Provider Name (Legal Business Name): PATRICIA METSALA ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ORLANDO AVE STE 280
WINTER PARK FL
32789-3639
US

IV. Provider business mailing address

10555 FAIRHAVEN WAY
ORLANDO FL
32825-7173
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-2336
  • Fax: 407-644-7967
Mailing address:
  • Phone: 407-381-3287
  • Fax: 407-644-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: