Provider Demographics
NPI:1225173834
Name:MCCRARY, PADMINI (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PADMINI
Middle Name:
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 HEARTLAND CIR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-6515
Mailing Address - Country:US
Mailing Address - Phone:863-646-4760
Mailing Address - Fax:
Practice Address - Street 1:726 HEARTLAND CIR
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-6515
Practice Address - Country:US
Practice Address - Phone:863-646-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0006014282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital