Provider Demographics
NPI:1710158712
Name:AGARD-RYAN, LINDA GENE (OT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GENE
Last Name:AGARD-RYAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GENE
Other - Last Name:AGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:12124 HIGH TECH AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8373
Mailing Address - Country:US
Mailing Address - Phone:407-382-0682
Mailing Address - Fax:407-382-4930
Practice Address - Street 1:12124 HIGH TECH AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8373
Practice Address - Country:US
Practice Address - Phone:407-382-0682
Practice Address - Fax:407-382-4930
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist