MEDICARE: JETA CHERY OTR

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
1	224Z00000X	Occupational Therapy Assistant	OTA 14254	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912359688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JETA CHERY OTR

Provider Business Mailing Address
First Line	:	5975 LAKE POINTE VILLAGE CIR APT 711
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-3569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 LAKE POINTE VILLAGE CIR APT 711
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-3569
Country	:	US
Telephone Number	:	321-279-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	01/25/2022

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Directions to “ JETA CHERY OTR” Practice Location

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