Provider Demographics
NPI:1083809230
Name:WINTER, DOUGLAS JEROME (OTR/L)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JEROME
Last Name:WINTER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:DOUG
Other - Middle Name:J
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8846 CR 535
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836
Mailing Address - Country:US
Mailing Address - Phone:407-876-4350
Mailing Address - Fax:
Practice Address - Street 1:8846 CR 535
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836
Practice Address - Country:US
Practice Address - Phone:407-876-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12723225X00000X, 225XH1200X
OT12723225XP0019X
IL056.008601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892547000Medicaid