Provider Demographics
NPI:1174735419
Name:GUCKENBERGER, DARLENE FAYE (OTR-L)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:FAYE
Last Name:GUCKENBERGER
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 1:2666 N MCMULLEN BOOTH RD
Mailing Address - Street 2:#1032
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4404
Mailing Address - Country:US
Mailing Address - Phone:727-437-7027
Mailing Address - Fax:
Practice Address - Street 1:2666 N MCMULLEN BOOTH RD
Practice Address - Street 2:#1032
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4404
Practice Address - Country:US
Practice Address - Phone:727-437-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891773600Medicaid