Healthcare Provider Details

I. General information

NPI: 1942721212
Provider Name (Legal Business Name): STEPHANIE MELENDEZ PEREZ COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-1653
US

IV. Provider business mailing address

9000 BRAMBLE WAY LN
ORLANDO FL
32825-3750
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-3336
  • Fax:
Mailing address:
  • Phone: 407-435-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number15730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: