Provider Demographics
NPI:1700467529
Name:ROUNDTREE, OTUNNAL O (OT, PTA)
Entity Type:Individual
Prefix:
First Name:OTUNNAL
Middle Name:O
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:OT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 JIM LEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-7055
Mailing Address - Country:US
Mailing Address - Phone:850-728-0121
Mailing Address - Fax:
Practice Address - Street 1:8213 KILLEARN LAKES TER
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-4144
Practice Address - Country:US
Practice Address - Phone:850-391-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist