Provider Demographics
NPI:1821202961
Name:GOLDEN, VICKY L (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:L
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3525
Mailing Address - Country:US
Mailing Address - Phone:760-224-5240
Mailing Address - Fax:760-602-8430
Practice Address - Street 1:2270 LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3525
Practice Address - Country:US
Practice Address - Phone:760-224-5240
Practice Address - Fax:760-602-8430
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21009225X00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist