Provider Demographics
NPI:1598144057
Name:PEPPER, CYNTHIA I (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:I
Last Name:PEPPER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:I
Other - Last Name:ZWICKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:440 NE 4TH AVE UNIT 722
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3457
Mailing Address - Country:US
Mailing Address - Phone:754-300-8687
Mailing Address - Fax:
Practice Address - Street 1:440 NE 4TH AVE UNIT 722
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:754-300-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLOT 17671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018026200Medicaid
FL020812900Medicaid