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General NPI Number Information
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NPI Number | 1023210630
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH WILLETTE OT
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 306 NE 3RD ST
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2949
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Country | US
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Telephone | 863-357-4994
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Fax | 863-357-4912
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Provider Business Mailing Address
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Address Line | 1323 CARIBBEAN WAY
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City | LANTANA
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State | FL
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Zip | 33462-4252
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Country | US
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Telephone | 561-586-2282
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Fax | 863-357-4912
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT 9148
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License Number State | FL
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