Provider Demographics
NPI:1184363426
Name:WINSTON, GENEVIEVE
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:WINSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 MALABAR LAKES DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4455
Mailing Address - Country:US
Mailing Address - Phone:863-512-9065
Mailing Address - Fax:
Practice Address - Street 1:1634 SALADINO ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5425
Practice Address - Country:US
Practice Address - Phone:833-684-5439
Practice Address - Fax:321-286-3020
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist