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General NPI Number Information
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NPI Number | 1588974992
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH OF ORLANDO LLC
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 425 ALEXANDRIA BLVD SUITE 1010
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City | OVIEDO
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State | FL
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Zip | 32765-5516
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Country | US
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Telephone | 407-977-3842
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Fax | 407-977-3433
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Provider Business Mailing Address
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Address Line | 425 ALEXANDRIA BLVD SUITE 1010
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City | OVIEDO
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State | FL
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Zip | 32765-5516
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Country | US
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Telephone | 407-977-3842
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Fax | 407-977-3433
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC OTT
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Credential |
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Telephone | 407-977-3842
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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 | OS9108
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License Number State | FL
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