Provider Demographics
NPI:1134493570
Name:BANNISTER, MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 HEATHER RUN DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9526
Mailing Address - Country:US
Mailing Address - Phone:904-538-0680
Mailing Address - Fax:888-393-1099
Practice Address - Street 1:151 SAWGRASS CORNERS DR
Practice Address - Street 2:STE 117
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3553
Practice Address - Country:US
Practice Address - Phone:904-371-4649
Practice Address - Fax:888-393-1099
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2021-04-20
Deactivation Date:2019-04-21
Deactivation Code:
Reactivation Date:2021-04-20
Provider Licenses
StateLicense IDTaxonomies
FLOT12785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist