Provider Demographics
NPI:1871538454
Name:INDA, JAMES JONATHAN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JONATHAN
Last Name:INDA
Suffix:
Gender:M
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 1:424 LUNA BELLA LN APT 317
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-4683
Mailing Address - Country:US
Mailing Address - Phone:321-277-1983
Mailing Address - Fax:407-302-8064
Practice Address - Street 1:424 LUNA BELLA LN APT 317
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-4683
Practice Address - Country:US
Practice Address - Phone:321-277-1983
Practice Address - Fax:407-302-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005173225X00000X
FLOT9735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3330ZMedicare ID - Type UnspecifiedOT PROVIDER NUMBER
MIP31010001Medicare ID - Type UnspecifiedMEMBER#