Provider Demographics
NPI:1336371897
Name:WILMOT, JODI S (MPH OTR/L)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:WILMOT
Suffix:
Gender:F
Credentials:MPH OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 MAGNOLIA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7065
Mailing Address - Country:US
Mailing Address - Phone:850-230-1802
Mailing Address - Fax:850-230-8949
Practice Address - Street 1:6012 MAGNOLIA BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7065
Practice Address - Country:US
Practice Address - Phone:850-230-1802
Practice Address - Fax:850-230-8949
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist