Provider Demographics
NPI:1952786527
Name:WOOTTEN, CHRIS CLAYTON (COTA)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:CLAYTON
Last Name:WOOTTEN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 DUNCAN LOOP NORTH
Mailing Address - Street 2:APT 103
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:386-214-3764
Mailing Address - Fax:
Practice Address - Street 1:1360 DUNCAN LOOP N
Practice Address - Street 2:APT 103
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8399
Practice Address - Country:US
Practice Address - Phone:386-214-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12332224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant