Provider Demographics
NPI:1770537359
Name:WOOTEN, JANICE LOUISE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LOUISE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 WINGROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3346
Mailing Address - Country:US
Mailing Address - Phone:407-298-0684
Mailing Address - Fax:407-905-8958
Practice Address - Street 1:301 S WEST CROWN POINT RD STE 150
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2917
Practice Address - Country:US
Practice Address - Phone:407-905-8908
Practice Address - Fax:407-905-8958
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812290300Medicaid
FL884790800Medicaid