Provider Demographics
NPI:1881654432
Name:FLORENTINE, MAJA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MAJA
Middle Name:ANN
Last Name:FLORENTINE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 LAKE DEBRA DR
Mailing Address - Street 2:APARTMENT 8208
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8725
Mailing Address - Country:US
Mailing Address - Phone:860-836-6036
Mailing Address - Fax:
Practice Address - Street 1:409 E OAKLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-3070
Practice Address - Country:US
Practice Address - Phone:407-654-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001638225X00000X
FLOT-17170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015736000Medicaid