Individual
DIANA LYNN VISSER-FARTEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA16477
Contact information
Practice address
4000 KINGS HWY, PORT CHARLOTTE, FL 33980-8718
(941) 255-9006
Mailing address
23252 ROUNTREE AVE # 4, PUNTA GORDA, FL 33980-7302
(239) 443-0511
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
16477
FL
Other
Enumeration date
10/26/2020
Last updated
10/28/2020
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