Provider Demographics
NPI:1477913945
Name:ATEHORTUA, HUGO (OT17640)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:ATEHORTUA
Suffix:
Gender:M
Credentials:OT17640
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SE MARICAMP RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5582
Mailing Address - Country:US
Mailing Address - Phone:352-732-8868
Mailing Address - Fax:352-732-8890
Practice Address - Street 1:4600 SW 46TH CT STE 140
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5785
Practice Address - Country:US
Practice Address - Phone:352-873-3058
Practice Address - Fax:352-873-3726
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT17640OtherOCCUPATIONAL LICIENCE