Provider Demographics
NPI:1073278693
Name:CHADWICK, MARY (MOT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 WINDSOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8064
Mailing Address - Country:US
Mailing Address - Phone:407-970-3712
Mailing Address - Fax:
Practice Address - Street 1:8119 WINDSOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8064
Practice Address - Country:US
Practice Address - Phone:407-970-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18996225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics