Provider Demographics
NPI:1386306389
Name:DASS, SUPRIYA (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:SUPRIYA
Middle Name:
Last Name:DASS
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 1:4040 SE 20TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7178
Mailing Address - Country:US
Mailing Address - Phone:352-484-9819
Mailing Address - Fax:
Practice Address - Street 1:4040 SE 20TH CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7178
Practice Address - Country:US
Practice Address - Phone:352-484-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist