Provider Demographics
NPI:1710251095
Name:GUIDERA, CARMEN RENEE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:RENEE
Last Name:GUIDERA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 CLUBSIDE CT
Mailing Address - Street 2:511
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1757
Mailing Address - Country:US
Mailing Address - Phone:419-302-1167
Mailing Address - Fax:
Practice Address - Street 1:2471 CLUBSIDE CT
Practice Address - Street 2:511
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1757
Practice Address - Country:US
Practice Address - Phone:419-302-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist