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NPI Code Detail

MEDICARE: GRACE PORTOGHESE OT

MEDICARE: GRACE PORTOGHESE OT
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 15904FL

General Provider Information

NPI Number : 1699108126
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE PORTOGHESE OT
Provider Business Mailing Address
First Line : 13540 17TH ST
Second Line :
City : DADE CITY
State : FL
Zip : 33525-5244
Country : US
Telephone Number : 352-437-5151
Fax Number : 813-212-3870
Provider Business Practice Location Address
First Line : 13540 17TH ST
Second Line :
City : DADE CITY
State : FL
Zip : 33525-5244
Country : US
Telephone Number : 352-437-5151
Fax Number : 813-212-3870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2013
Last Update Date : 07/13/2023

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Directions to “ GRACE PORTOGHESE OT” Practice Location

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