Healthcare Provider Details

I. General information

NPI: 1649577032
Provider Name (Legal Business Name): ANNA COLLEEN BLAZINA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JULIE LN
BRANDON FL
33511-6403
US

IV. Provider business mailing address

504 S KINGS AVE # 223
BRANDON FL
33511-5922
US

V. Phone/Fax

Practice location:
  • Phone: 813-575-2327
  • Fax:
Mailing address:
  • Phone: 813-575-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT14487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: