MEDICARE: CHARLES RAPOSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA 12829	FL

General Provider Information

NPI Number	:	1063826279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES RAPOSA

Provider Business Mailing Address
First Line	:	31790 US HIGHWAY 19 N APT 89
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3717
Country	:	US
Telephone Number	:	727-599-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	31790 US HIGHWAY 19 N APT 89
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3717
Country	:	US
Telephone Number	:	727-599-9169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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Directions to “ CHARLES RAPOSA ” Practice Location

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