Provider Demographics
NPI:1700040961
Name:DUTTON, GERMAINE P (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:GERMAINE
Middle Name:P
Last Name:DUTTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10712 TAVISTOCK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1721
Mailing Address - Country:US
Mailing Address - Phone:813-675-5684
Mailing Address - Fax:
Practice Address - Street 1:10712 TAVISTOCK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1721
Practice Address - Country:US
Practice Address - Phone:813-675-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003882225X00000X
FL9109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist