Individual
CHELSEA RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
761 COUNTY ROAD 466, LADY LAKE, FL 32159
(352) 259-9749
(352) 259-8209
Mailing address
761 COUNTY ROAD 466, LADY LAKE, FL 32159
(352) 259-9749
(352) 259-8209
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
POR322
FL
224900000X
Mastectomy Fitter
CFM02896
—
224P00000X
Prosthetist
Primary
POR322
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPO03691
AMERICAN BOARD CERTIFICATION FOR PROSTHETICS & ORTHOTICS
—
01
—
POR322
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
06/22/2018
Last updated
08/09/2018
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