Provider Demographics
NPI:1285980433
Name:DOUGLAS, PATRIA LE'NICA (MSOT)
Entity type:Individual
Prefix:MISS
First Name:PATRIA
Middle Name:LE'NICA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 50TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-9411
Mailing Address - Country:US
Mailing Address - Phone:305-587-4441
Mailing Address - Fax:
Practice Address - Street 1:7172 50TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9411
Practice Address - Country:US
Practice Address - Phone:305-587-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT00957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist