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NPI Code Detail

MEDICARE: ERIKA WANDA STEVENS COTA/L

MEDICARE: ERIKA WANDA STEVENS COTA/L
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
1224Z00000XOccupational Therapy AssistantOTA17796FL

General Provider Information

NPI Number : 1508459090
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIKA WANDA STEVENS COTA/L
Provider Business Mailing Address
First Line : 1112 BLACK KNIGHT DR
Second Line :
City : VALRICO
State : FL
Zip : 33594-5800
Country : US
Telephone Number : 813-789-3694
Fax Number :
Provider Business Practice Location Address
First Line : 1514 E CHELSEA ST
Second Line :
City : TAMPA
State : FL
Zip : 33610-6114
Country : US
Telephone Number : 813-238-6406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2021
Last Update Date : 02/16/2021

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