Provider Demographics
NPI:1336313709
Name:SALVADOR, MARK W (OTR)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:SALVADOR
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 HARBOR HILL ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4615
Mailing Address - Country:US
Mailing Address - Phone:407-656-1315
Mailing Address - Fax:
Practice Address - Street 1:1105 HARBOR HILL ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4615
Practice Address - Country:US
Practice Address - Phone:407-656-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist