Provider Demographics
NPI:1508293010
Name:DEREXSON, NANCY L (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:DEREXSON
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 1:7836 KAY MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-7729
Mailing Address - Country:US
Mailing Address - Phone:813-404-6619
Mailing Address - Fax:
Practice Address - Street 1:1445 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-1502
Practice Address - Country:US
Practice Address - Phone:813-727-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 7005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist