Provider Demographics
NPI:1184275737
Name:DISILVESTRO, DENNIS (OT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DISILVESTRO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 WHISKEY CREEK DR APT 809
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8746
Mailing Address - Country:US
Mailing Address - Phone:239-470-8515
Mailing Address - Fax:
Practice Address - Street 1:6150 WHISKEY CREEK DR APT 809
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8746
Practice Address - Country:US
Practice Address - Phone:239-470-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist