Provider Demographics
NPI:1972843845
Name:HOWARD, IDA NADINE (OT)
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:NADINE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 BRIDLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6250
Mailing Address - Country:US
Mailing Address - Phone:813-681-3203
Mailing Address - Fax:
Practice Address - Street 1:701 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4100
Practice Address - Country:US
Practice Address - Phone:813-681-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist