Provider Demographics
NPI:1912769506
Name:FOURQUREAN, SAVANNAH DEE (OTD, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:SAVANNAH
Middle Name:DEE
Last Name:FOURQUREAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15939 KINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1625
Mailing Address - Country:US
Mailing Address - Phone:813-601-5002
Mailing Address - Fax:
Practice Address - Street 1:2150 PALM HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5363
Practice Address - Country:US
Practice Address - Phone:727-773-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist