Provider Demographics
NPI:1659575074
Name:REALE, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:REALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 PALE MOON DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-7721
Mailing Address - Country:US
Mailing Address - Phone:850-082-3419
Mailing Address - Fax:850-484-9525
Practice Address - Street 1:6000 PALE MOON DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-7721
Practice Address - Country:US
Practice Address - Phone:850-982-3419
Practice Address - Fax:850-492-7371
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 3692225XP0200X
FLOT3692225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing