Provider Demographics
NPI:1215219159
Name:CANTRELL, DOTIE LINIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DOTIE
Middle Name:LINIA
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:DOTIE
Other - Middle Name:LINIA
Other - Last Name:CANTRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1480 SWANSON DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5811
Mailing Address - Country:US
Mailing Address - Phone:407-971-2900
Mailing Address - Fax:407-971-2943
Practice Address - Street 1:1480 SWANSON DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5811
Practice Address - Country:US
Practice Address - Phone:407-971-2900
Practice Address - Fax:407-971-2943
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 34817225700000X
FLMA34817225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist