Provider Demographics
NPI:1659385961
Name:AUNSPAUGH, VICKI LYNN (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:AUNSPAUGH
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 S CLYDE MORRIS BLVD
Mailing Address - Street 2:ST. 300
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-2300
Mailing Address - Country:US
Mailing Address - Phone:386-258-8080
Mailing Address - Fax:386-258-8177
Practice Address - Street 1:3635 S CLYDE MORRIS BLVD
Practice Address - Street 2:ST. 300
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2300
Practice Address - Country:US
Practice Address - Phone:386-258-8080
Practice Address - Fax:386-258-8177
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1113225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880190800Medicaid
FLZ2238OtherBLUE CROSS BLUE SHIELD FL
FL670000721OtherRAILROAD MEDICARE
FLZ2238AMedicare ID - Type Unspecified