Provider Demographics
NPI:1164007399
Name:FAAS, DOUGLAS (OT 17824)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:FAAS
Suffix:
Gender:M
Credentials:OT 17824
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-2465
Mailing Address - Country:US
Mailing Address - Phone:239-425-2525
Mailing Address - Fax:
Practice Address - Street 1:CALUSA HARBOUR
Practice Address - Street 2:2525 FIRST ST.
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-425-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17824225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123456789Medicaid