Provider Demographics
NPI:1679167548
Name:STIMSON, JANNA
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:STIMSON
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 1:1711 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5954
Mailing Address - Country:US
Mailing Address - Phone:585-356-9270
Mailing Address - Fax:
Practice Address - Street 1:1711 NE 60TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-5954
Practice Address - Country:US
Practice Address - Phone:585-356-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14578225XE0001X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT14578OtherOCCUPATIONAL THERAPY LICENSE