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General NPI Number Information
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NPI Number | 1811223431
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Entity Type | Individual
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Provider Name | JENNIFER ANN MANDATO OTD,MED,OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 6102 GREATWATER DR
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City | WINDERMERE
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State | FL
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Zip | 34786-5600
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Country | US
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Telephone | 689-207-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 6102 GREATWATER DR
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City | WINDERMERE
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State | FL
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Zip | 34786-5600
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Country | US
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Telephone |
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Fax |
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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 | 20630
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 008652-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 21363
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 011217
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 008652-1
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | FL
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