Healthcare Provider Details

I. General information

NPI: 1265771745
Provider Name (Legal Business Name): VALERIE ANN CASTELLANO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 ROSELAND RD
SEBASTIAN FL
32958-8218
US

IV. Provider business mailing address

1002 ROSELAND RD
SEBASTIAN FL
32958-8218
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-9424
  • Fax: 772-778-1493
Mailing address:
  • Phone: 772-581-9424
  • Fax: 772-778-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 10281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: