Basic Information
| Provider Information | |||||||||
| NPI: | 1952502478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2679 N FOREST RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344425123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527462371 | ||||||||
| FaxNumber: | 3527463729 | ||||||||
| Practice Location | |||||||||
| Address1: | 2679 N FOREST RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344425123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527462371 | ||||||||
| FaxNumber: | 3527463729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA9248 | FL | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225700000X | MA21792 | FL | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.