Provider Demographics
NPI:1801062294
Name:METSALA, PATRICIA (ITDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:METSALA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 FAIRHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7173
Mailing Address - Country:US
Mailing Address - Phone:407-381-3287
Mailing Address - Fax:407-644-7967
Practice Address - Street 1:140 N ORLANDO AVE STE 280
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3639
Practice Address - Country:US
Practice Address - Phone:407-539-2336
Practice Address - Fax:407-644-7967
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist