Provider Demographics
NPI:1518275296
Name:WHALEY, MIRTHA MONTEJO (PHD, OTRL)
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:MONTEJO
Last Name:WHALEY
Suffix:
Gender:F
Credentials:PHD, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CHAPMAN RD E
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5779
Mailing Address - Country:US
Mailing Address - Phone:813-909-9679
Mailing Address - Fax:
Practice Address - Street 1:414 CHAPMAN RD E
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5779
Practice Address - Country:US
Practice Address - Phone:813-909-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 0949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist