Provider Demographics
NPI:1306404256
Name:CORTES-THOMAS, MISTY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CORTES-THOMAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-8773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4410 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8130
Practice Address - Country:US
Practice Address - Phone:859-492-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5527225X00000X
FLOT21401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist