Provider Demographics
NPI:1528795606
Name:WHITEHEAD, VIJI ALVINO (COTA)
Entity type:Individual
Prefix:
First Name:VIJI
Middle Name:ALVINO
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6710
Mailing Address - Country:US
Mailing Address - Phone:863-533-0578
Mailing Address - Fax:
Practice Address - Street 1:2055 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6710
Practice Address - Country:US
Practice Address - Phone:863-533-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10608224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant