Provider Demographics
NPI:1619117918
Name:JABADOSS, VISWASAM MANUEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:VISWASAM
Middle Name:MANUEL
Last Name:JABADOSS
Suffix:
Gender:M
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 1:17125 DILLARD CT
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-2008
Mailing Address - Country:US
Mailing Address - Phone:813-948-0593
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B.DOWNS BLVD
Practice Address - Street 2:JAMES A.HALEY VETRANS HOSPITAL
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist