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NPI Code Detail

MEDICARE: AZENITH CASUPANG OTR/L

MEDICARE: AZENITH CASUPANG OTR/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
1225X00000XOccupational TherapistOT15464FL

General Provider Information

NPI Number : 1558513861
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZENITH CASUPANG OTR/L
Provider Business Mailing Address
First Line : 38921 HARBORWOODS PL
Second Line :
City : LADY LAKE
State : FL
Zip : 32159-6056
Country : US
Telephone Number : 443-813-9498
Fax Number :
Provider Business Practice Location Address
First Line : 701 LAKE PORT BLVD
Second Line :
City : LEESBURG
State : FL
Zip : 34748-7674
Country : US
Telephone Number : 352-728-3366
Fax Number : 352-435-0206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2008
Last Update Date : 12/09/2022

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Directions to “ AZENITH CASUPANG OTR/L” Practice Location

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