MEDICARE: CAROL ANN DEFAZIO MSOT

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	225X00000X	Occupational Therapist	OT13709	FL

General Provider Information

NPI Number	:	1417448101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN DEFAZIO MSOT

Provider Business Mailing Address
First Line	:	552 10TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6823
Country	:	US
Telephone Number	:	772-494-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 10TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6823
Country	:	US
Telephone Number	:	772-494-3010
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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Directions to “ CAROL ANN DEFAZIO MSOT” Practice Location

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