Provider Demographics
NPI:1467119297
Name:BALTRUCKI, CAROLINE (OT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BALTRUCKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:8477 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5028
Mailing Address - Country:US
Mailing Address - Phone:800-804-9961
Mailing Address - Fax:352-382-1146
Practice Address - Street 1:2660 SW 53RD LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3981
Practice Address - Country:US
Practice Address - Phone:352-378-7108
Practice Address - Fax:352-382-1146
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist