Individual
EDWIN DOUGLASS IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2629 DEL PRADO BLVD S, CAPE CORAL, FL 33904-5769
(239) 574-4434
Mailing address
6200 MAHAFFEY RD UNIT 106, FORT MYERS, FL 33966-1646
(716) 609-4072
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA19164
FL
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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