Healthcare Provider Details

I. General information

NPI: 1184203531
Provider Name (Legal Business Name): STACEY MALINDA MIOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 STATE ROAD 580 STE 111
CLEARWATER FL
33761-3351
US

IV. Provider business mailing address

2753 STATE ROAD 580 STE 111
CLEARWATER FL
33761-3351
US

V. Phone/Fax

Practice location:
  • Phone: 727-724-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number384170
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: