Provider Demographics
NPI:1609478395
Name:JAHREIS, DENICE
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:JAHREIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENICE
Other - Middle Name:LYNN
Other - Last Name:RICHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10213 TROUT LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6557
Mailing Address - Country:US
Mailing Address - Phone:321-663-4501
Mailing Address - Fax:
Practice Address - Street 1:1061 TOMYN BLVD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4939
Practice Address - Country:US
Practice Address - Phone:407-906-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist