MEDICARE: LISA MARIE ROCCIA OTRL

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	225XP0200X	Pediatric Occupational Therapist	12535	FL

General Provider Information

NPI Number	:	1699814467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE ROCCIA OTRL

Provider Business Mailing Address
First Line	:	3135 HILLSIDE LN
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-5338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3670
Country	:	US
Telephone Number	:	727-786-5482
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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