Healthcare Provider Details

I. General information

NPI: 1023667128
Provider Name (Legal Business Name): TANIA L MONTANEZ BENITEZ COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S ORANGE BLOSSOM TRL STE 102
ORLANDO FL
32809-5734
US

IV. Provider business mailing address

7840 GILLINGHAM CT
ORLANDO FL
32825-3371
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 321-215-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number17423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: