Provider Demographics
NPI:1437636578
Name:DOUGLAS, JUNE ANNETTE
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:ANNETTE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAN LINO CIR UNIT 123
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-6314
Mailing Address - Country:US
Mailing Address - Phone:941-224-7426
Mailing Address - Fax:
Practice Address - Street 1:5201 DESOTO RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-3607
Practice Address - Country:US
Practice Address - Phone:941-256-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist