Provider Demographics
NPI:1174237267
Name:WOLMARANS, JORDAN (OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WOLMARANS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:BELLEMARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11714 CASA LAGO LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3368
Mailing Address - Country:US
Mailing Address - Phone:941-704-8166
Mailing Address - Fax:
Practice Address - Street 1:2626 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1933
Practice Address - Country:US
Practice Address - Phone:941-704-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist