Healthcare Provider Details

I. General information

NPI: 1275893133
Provider Name (Legal Business Name): MARIA L ACEVEDO OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 HABANA WAY
TAMPA FL
33614-7108
US

IV. Provider business mailing address

8903 SHELDON CHASE DR
TAMPA FL
33635-1092
US

V. Phone/Fax

Practice location:
  • Phone: 813-227-4347
  • Fax:
Mailing address:
  • Phone: 813-880-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License NumberOTA5625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: