Provider Demographics
NPI:1417026220
Name:PLANTIJN, EDMOLY
Entity Type:Individual
Prefix:
First Name:EDMOLY
Middle Name:
Last Name:PLANTIJN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WINDSOR OAK DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7672
Mailing Address - Country:US
Mailing Address - Phone:407-814-7588
Mailing Address - Fax:
Practice Address - Street 1:652 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7841
Practice Address - Country:US
Practice Address - Phone:407-339-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2926OtherLICENSE#