Healthcare Provider Details

I. General information

NPI: 1982967402
Provider Name (Legal Business Name): DEMETRIOS INTZES COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 FOREST WOOD CT
SPRING HILL FL
34609-9455
US

IV. Provider business mailing address

333 FOREST WOOD CT
SPRING HILL FL
34609-9455
US

V. Phone/Fax

Practice location:
  • Phone: 352-346-9259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA5623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: