Individual
GRACE PORTOGHESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
13540 17TH ST, DADE CITY, FL 33525-5244
(352) 437-5151
(813) 212-3870
Mailing address
13540 17TH ST, DADE CITY, FL 33525-5244
(352) 437-5151
(813) 212-3870
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 15904
FL
Other
Enumeration date
08/20/2013
Last updated
07/13/2023
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