Provider Demographics
NPI:1568778769
Name:BUSH, SALENA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:MARIE
Last Name:BUSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SALENA
Other - Middle Name:MARIE
Other - Last Name:STOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:260 1ST AVE S STE 200-161
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4361
Mailing Address - Country:US
Mailing Address - Phone:727-803-1102
Mailing Address - Fax:
Practice Address - Street 1:4540 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2567
Practice Address - Country:US
Practice Address - Phone:727-803-1102
Practice Address - Fax:727-502-6027
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14287225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist