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General NPI Number Information
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NPI Number | 1578383543
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Entity Type | Individual
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Provider Name | VANESSA SEPULVEDA OTR
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1337 S INTERNATIONAL PKWY STE 1321
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City | LAKE MARY
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State | FL
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Zip | 32746-1402
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Country | US
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Telephone | 407-833-0802
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Fax | 407-833-8931
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Provider Business Mailing Address
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Address Line | 100 E 2ND AVE STE 210
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City | ROME
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State | GA
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Zip | 30161-1718
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Country | US
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Telephone | 407-833-0802
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Fax | 407-833-8931
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT25673
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License Number State | FL
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