Provider Demographics
NPI:1760925325
Name:DRAPER, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DRAPER
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 1:12988 SPRING RAIN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5200
Mailing Address - Country:US
Mailing Address - Phone:904-446-6987
Mailing Address - Fax:
Practice Address - Street 1:350 CORPORATE WAY
Practice Address - Street 2:250
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2874
Practice Address - Country:US
Practice Address - Phone:904-731-3515
Practice Address - Fax:904-213-7654
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYPPW16012527OtherBLUECROSS BLUESHIELD