Provider Demographics
NPI:1710709738
Name:SORTINO, MEGAN (OTR/L, CLT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SORTINO
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WHITTIER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2119
Mailing Address - Country:US
Mailing Address - Phone:205-903-6283
Mailing Address - Fax:
Practice Address - Street 1:521 W STATE ROAD 434 STE 204
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5165
Practice Address - Country:US
Practice Address - Phone:407-767-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist