Provider Demographics
NPI:1487176079
Name:CAVENDER, CHRISTINE (MOT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 VIA DE RENEE PL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6302
Mailing Address - Country:US
Mailing Address - Phone:335-239-4128
Mailing Address - Fax:
Practice Address - Street 1:615 E PRINCETON ST STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1435
Practice Address - Country:US
Practice Address - Phone:407-303-1575
Practice Address - Fax:407-303-1564
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist