Provider Demographics
NPI:1285312116
Name:WOODLAND, CYNTHIA ANN (OTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:WOODLAND
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:ANN
Other - Last Name:CRADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:5753 HIGHWAY 85 N PMB 4084
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:239-908-7962
Mailing Address - Fax:
Practice Address - Street 1:BAY BREEZE SENIOR LIVING AND REHAB
Practice Address - Street 2:3387 GULF BREEZE PARKWAY
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563
Practice Address - Country:US
Practice Address - Phone:239-908-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13418224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant