Healthcare Provider Details

I. General information

NPI: 1750806972
Provider Name (Legal Business Name): CASEY CASTANEDO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

IV. Provider business mailing address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: