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NPI Code Detail

MEDICARE: AWILDA LORA O.T.

MEDICARE:   AWILDA  LORA  O.T.
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
1225X00000XOccupational Therapist6119FL

General Provider Information

NPI Number : 1225270770
Entity Type Code : Individual
Provider Name (Legal Business Name) : AWILDA LORA O.T.
Provider Business Mailing Address
First Line : 500 GRAND PLAZA DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-7900
Country : US
Telephone Number : 386-775-0855
Fax Number : 386-775-0274
Provider Business Practice Location Address
First Line : 500 GRAND PLAZA DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-7900
Country : US
Telephone Number : 386-775-0855
Fax Number : 386-775-0274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2009
Last Update Date : 03/30/2009

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Directions to “ AWILDA LORA O.T.” Practice Location

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