Healthcare Provider Details

I. General information

NPI: 1386445823
Provider Name (Legal Business Name): ANTHONY THOMAS SKODY OTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 NE 1ST AVE
FORT LAUDERDALE FL
33334-1601
US

IV. Provider business mailing address

5171 NE 1ST AVE
FORT LAUDERDALE FL
33334-1601
US

V. Phone/Fax

Practice location:
  • Phone: 954-298-5544
  • Fax:
Mailing address:
  • Phone: 954-298-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA12401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: