Provider Demographics
NPI:1033342589
Name:HUNSICKER, ATHENA
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:HUNSICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:
Other - Last Name:STEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2969
Mailing Address - Country:US
Mailing Address - Phone:904-278-7890
Mailing Address - Fax:
Practice Address - Street 1:550 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2969
Practice Address - Country:US
Practice Address - Phone:904-278-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist