Provider Demographics
NPI:1063562163
Name:WAINMAN, SANDRA G (OTR L)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:WAINMAN
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 1:1016 SPRING VILLAS POINTE
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708
Mailing Address - Country:US
Mailing Address - Phone:407-629-9455
Mailing Address - Fax:
Practice Address - Street 1:1016 SPRING VILLAS POINTE
Practice Address - Street 2:SUITE 1030
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708
Practice Address - Country:US
Practice Address - Phone:407-629-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0001880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist