Provider Demographics
NPI:1265641773
Name:UMALI, GRACE (OTRL)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:
Last Name:UMALI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E AMELIA ST
Mailing Address - Street 2:#1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5355
Mailing Address - Country:US
Mailing Address - Phone:407-616-6767
Mailing Address - Fax:
Practice Address - Street 1:2987 SUMMER SWAN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7405
Practice Address - Country:US
Practice Address - Phone:407-421-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist