Provider Demographics
NPI:1215204409
Name:HUENERFUERST, MAYFAIR BELLE GABUTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAYFAIR BELLE
Middle Name:GABUTIN
Last Name:HUENERFUERST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAYFAIR BELLE
Other - Middle Name:AGCOPRA
Other - Last Name:GABUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 BERKMAN CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6311
Mailing Address - Country:US
Mailing Address - Phone:321-527-9194
Mailing Address - Fax:
Practice Address - Street 1:11315 CORPORATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8344
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist