Provider Demographics
NPI:1871804682
Name:MAGNATTA, ANTONETTE (MOTR/L)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:
Last Name:MAGNATTA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0602
Mailing Address - Country:US
Mailing Address - Phone:313-506-8329
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL PKWY
Practice Address - Street 2:STE 300
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5061
Practice Address - Country:US
Practice Address - Phone:800-806-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist