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NPI Code Detail

MEDICARE: AGATA S MACDONALD OTR/L

MEDICARE: AGATA S MACDONALD OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT 9614FL

General Provider Information

NPI Number : 1376567792
Entity Type Code : Individual
Provider Name (Legal Business Name) : AGATA S MACDONALD OTR/L
Provider Business Mailing Address
First Line : 1473 GULF WINDS DR
Second Line :
City : GULF BREEZE
State : FL
Zip : 32563-1929
Country : US
Telephone Number : 850-932-2673
Fax Number :
Provider Business Practice Location Address
First Line : 4 JACKSON ST NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-4925
Country : US
Telephone Number : 850-862-7227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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Directions to “ AGATA S MACDONALD OTR/L” Practice Location

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