Provider Demographics
NPI:1376515601
Name:JETHWANI, MEENU (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEENU
Middle Name:
Last Name:JETHWANI
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:PO BOX 4949
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4949
Mailing Address - Country:US
Mailing Address - Phone:352-732-4006
Mailing Address - Fax:352-732-5006
Practice Address - Street 1:310 SE 29TH PL
Practice Address - Street 2:STE. 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0486
Practice Address - Country:US
Practice Address - Phone:352-732-4006
Practice Address - Fax:352-732-5006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-4799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ005ZOtherBLUE CROSS / BLUE SHIELD
FLK4081Medicare ID - Type Unspecified