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NPI Code Detail

MEDICARE: CANDACE C. DEILING COTA

MEDICARE: CANDACE C. DEILING COTA
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 AssistantOTA00005440FL

General Provider Information

NPI Number : 1538382965
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE C. DEILING COTA
Provider Business Mailing Address
First Line : 2658 EVERLETH CT
Second Line :
City : LAKELAND
State : FL
Zip : 33810-5133
Country : US
Telephone Number : 863-858-4653
Fax Number :
Provider Business Practice Location Address
First Line : 409 S 10TH ST
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-5603
Country : US
Telephone Number : 863-422-8656
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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Directions to “ CANDACE C. DEILING COTA” Practice Location

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