Provider Demographics
NPI:1366480477
Name:BRETON, JUSTIN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:BRETON
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 1:5121 NW 76TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1135
Mailing Address - Country:US
Mailing Address - Phone:352-262-4835
Mailing Address - Fax:386-496-4395
Practice Address - Street 1:5121 NW 76TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-1135
Practice Address - Country:US
Practice Address - Phone:352-262-4835
Practice Address - Fax:386-496-4395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 8940225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9784OtherBCBS OF FLORIDA