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NPI Code Detail

MEDICARE: MARISA NICOLE MOTES CONSTANT OTRL

MEDICARE: MARISA NICOLE MOTES CONSTANT OTRL
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 17524FL

General Provider Information

NPI Number : 1396199493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA NICOLE MOTES CONSTANT OTRL
Provider Business Mailing Address
First Line : 3901 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4312
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 PARK AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-3132
Country : US
Telephone Number : 904-278-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2016
Last Update Date : 04/15/2016

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Directions to “ MARISA NICOLE MOTES CONSTANT OTRL” Practice Location

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