Provider Demographics
NPI:1184660193
Name:PORTER, MARY ANN (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 KINSLEY PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6233
Mailing Address - Country:US
Mailing Address - Phone:407-672-2184
Mailing Address - Fax:407-672-2184
Practice Address - Street 1:3814 KINSLEY PL
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6233
Practice Address - Country:US
Practice Address - Phone:407-672-2184
Practice Address - Fax:407-679-2990
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7012Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER