Provider Demographics
NPI:1003338229
Name:WHITSON, JAMIE DELORIS (COTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DELORIS
Last Name:WHITSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WHITSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:HOMELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33847-0066
Mailing Address - Country:US
Mailing Address - Phone:863-221-9617
Mailing Address - Fax:
Practice Address - Street 1:2701 LAKE ALFRED RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1432
Practice Address - Country:US
Practice Address - Phone:863-298-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9501224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant