Provider Demographics
NPI:1760509715
Name:AGABERG, VINITA
Entity Type:Individual
Prefix:
First Name:VINITA
Middle Name:
Last Name:AGABERG
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 1:223 BUNKER CT
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2251
Mailing Address - Country:US
Mailing Address - Phone:386-871-0339
Mailing Address - Fax:
Practice Address - Street 1:223 BUNKER CT
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2251
Practice Address - Country:US
Practice Address - Phone:386-871-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR991480225X00000X
HIOT-610225X00000X
AL5118225X00000X
FLOT4854225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist