Provider Demographics
NPI:1730135112
Name:REDHEAD, JORDA (OTR)
Entity Type:Individual
Prefix:
First Name:JORDA
Middle Name:
Last Name:REDHEAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 RAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5160
Mailing Address - Country:US
Mailing Address - Phone:941-539-6454
Mailing Address - Fax:941-244-0107
Practice Address - Street 1:3600 WILLIAM PENN WAY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5236
Practice Address - Country:US
Practice Address - Phone:941-483-0746
Practice Address - Fax:941-244-0107
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1573ZMedicare ID - Type Unspecified