Provider Demographics
NPI:1285034868
Name:JEDDRIE, MARCIA (OTR/L, CLT, MT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:JEDDRIE
Suffix:
Gender:F
Credentials:OTR/L, CLT, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SPYGLASS CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-241-6543
Mailing Address - Fax:321-241-6513
Practice Address - Street 1:7000 SPYGLASS CT
Practice Address - Street 2:SUITE 120
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-241-6543
Practice Address - Fax:321-241-6513
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist