Provider Demographics
NPI:1679907588
Name:ODUM, SANTRESA M (OTR)
Entity type:Individual
Prefix:
First Name:SANTRESA
Middle Name:M
Last Name:ODUM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 RUNNER OAK DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545
Mailing Address - Country:US
Mailing Address - Phone:561-373-2639
Mailing Address - Fax:
Practice Address - Street 1:2170 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6602
Practice Address - Country:US
Practice Address - Phone:561-683-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2023-08-15
Deactivation Date:2022-09-01
Deactivation Code:
Reactivation Date:2023-08-15
Provider Licenses
StateLicense IDTaxonomies
FLOT15553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist