MEDICARE: MRS. ANDREA MARIE CAMICIA-LOGUE MS.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
1	225X00000X	Occupational Therapist	OT25439	FL

General Provider Information

NPI Number	:	1912722356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MARIE CAMICIA-LOGUE MS.OTR/L

Provider Business Mailing Address
First Line	:	6684 ASHBURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7316
Country	:	US
Telephone Number	:	561-235-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6684 ASHBURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7316
Country	:	US
Telephone Number	:	561-235-4566
Fax Number	:

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

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/25/2024

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