Douglas Faas, OT 17824

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

OT17824 Issued in FL

Practice address

Calusa Harbour
2525 First St.
Ft. Myers, FL 33901

Phone

(239) 425-2525

NPI assigned

Mar 9, 2021

Last updated

Mar 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1164007399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 FIRST ST",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339012465",
            "telephone_number": "239-425-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALUSA HARBOUR",
            "address_2": "2525 FIRST ST.",
            "city": "FT. MYERS",
            "state": "FL",
            "postal_code": "33901",
            "telephone_number": "239-425-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAAS",
        "first_name": "DOUGLAS",
        "credential": "OT 17824",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "FL",
            "license": "OT17824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123456789",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eyemart Express LLC
• Eypr Ome Health Care Inc
• Ez RX Bonita Springs LLC (My Choice Rx)
• Ez RX Bonita Springs LLC (My Choice RX)
• Ikechukwu V Ezenwa, PHARM.D., PH.D.
• Leah Faber, PSYD
• Carolina Fabian, LMFT
• Camila Shaiel Fabius
• Sarah Elizabeth Fabrizi, OTR/L
• Jordan Antonio Facey, PA-C

• Gerontology Occupational Therapist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Gerontology Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.