Provider Demographics
NPI:1619307378
Name:FOSTER, TALITHA LAWSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:LAWSON
Last Name:FOSTER
Suffix:
Gender:F
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-0114
Mailing Address - Country:US
Mailing Address - Phone:321-890-4026
Mailing Address - Fax:
Practice Address - Street 1:4450 W EAU GALLIE BLVD STE 180
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7277
Practice Address - Country:US
Practice Address - Phone:321-255-6627
Practice Address - Fax:321-253-9777
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6746225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics