Provider Demographics
NPI:1518065382
Name:ESTEVES, JOHN (OT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ESTEVES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:JUAN CARLO
Other - Middle Name:
Other - Last Name:ESTEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:555 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2617
Mailing Address - Country:US
Mailing Address - Phone:843-777-2250
Mailing Address - Fax:843-777-2051
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-2250
Practice Address - Fax:843-777-2051
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11396225X00000X
SC3518225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ087POtherBCBS FL
FL889420500Medicaid