Provider Demographics
NPI:1912125501
Name:SADUCAS, JESSAMINE JOYCE GABUTIN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JESSAMINE JOYCE
Middle Name:GABUTIN
Last Name:SADUCAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JESSAMINE JOYCE
Other - Middle Name:MABANTO
Other - Last Name:GABUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2811 RULEME ST APT 206
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6539
Mailing Address - Country:US
Mailing Address - Phone:352-678-0015
Mailing Address - Fax:
Practice Address - Street 1:411 N DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2816
Practice Address - Country:US
Practice Address - Phone:407-296-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist