Provider Demographics
NPI:1073642203
Name:MEDINA, ACE STERLING ROXAS (OT)
Entity Type:Individual
Prefix:MR
First Name:ACE STERLING
Middle Name:ROXAS
Last Name:MEDINA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 AVENUE C SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3273
Mailing Address - Country:US
Mailing Address - Phone:863-293-3700
Mailing Address - Fax:863-292-0417
Practice Address - Street 1:141 AVENUE C SW
Practice Address - Street 2:SUITE 150
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3273
Practice Address - Country:US
Practice Address - Phone:863-293-3700
Practice Address - Fax:863-292-0417
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY910GOtherBCBS
FLY910JOtherBCBS
FLK0936BMedicare ID - Type UnspecifiedGROUP NO.
FLY910GOtherBCBS
FLE2380XMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO.