Individual
MRS. JEANETTE WIDEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
709 DOCTOR AVE, SEBASTIAN, FL 32958-4821
(772) 913-1517
Mailing address
709 DOCTOR AVE, SEBASTIAN, FL 32958-4821
(772) 913-1517
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA6186
FL
Other
Enumeration date
12/23/2010
Last updated
12/23/2010
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