Provider Demographics
NPI:1346753563
Name:PORTER, IRA (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REDWOOD TRACK LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-1954
Mailing Address - Country:US
Mailing Address - Phone:954-294-2938
Mailing Address - Fax:
Practice Address - Street 1:21 REDWOOD TRACK LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-1954
Practice Address - Country:US
Practice Address - Phone:954-294-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA6178224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant