Provider Demographics
NPI:1326387473
Name:FRAZER, MARC T (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:T
Last Name:FRAZER
Suffix:
Gender:M
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 1:14627 SW 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKER
Mailing Address - State:FL
Mailing Address - Zip Code:32622-2864
Mailing Address - Country:US
Mailing Address - Phone:352-485-1490
Mailing Address - Fax:352-955-5906
Practice Address - Street 1:14627 SW 155TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-2864
Practice Address - Country:US
Practice Address - Phone:352-485-1490
Practice Address - Fax:352-955-5906
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist