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Individual

MS. CYNTHIA JEAN PETITO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
1409 KINGSLEY AVE, SUITE 3A, ORANGE PARK, FL 32073-4537
(904) 315-7070
(904) 541-1413
Mailing address
PO BOX 916, ORANGE PARK, FL 32067-0916
(904) 315-7070
(904) 541-1413

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT6298
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
U6121Z
MEDICARE GROUP PTAN - OT
FL
Enumeration date
11/23/2005
Last updated
03/03/2015
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