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General NPI Number Information
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NPI Number | 1821071713
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Entity Type | Individual
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Provider Name | CYNTHIA JEAN PETITO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE SUITE 3A
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-315-7070
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Fax | 904-541-1413
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Provider Business Mailing Address
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Address Line | PO BOX 916
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City | ORANGE PARK
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State | FL
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Zip | 32067-0916
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Country | US
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Telephone | 904-315-7070
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Fax | 904-541-1413
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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 | OT6298
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License Number State | FL
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