Provider Demographics
NPI:1588710438
Name:VELDWIJK, CLARENA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CLARENA
Middle Name:
Last Name:VELDWIJK
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 1:945 W KELLER ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-8812
Mailing Address - Country:US
Mailing Address - Phone:352-746-2928
Mailing Address - Fax:
Practice Address - Street 1:538 N LECANTO HWY STE 538
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8547
Practice Address - Country:US
Practice Address - Phone:352-746-3300
Practice Address - Fax:352-746-0569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 5260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884409700Medicaid