Healthcare Provider Details

I. General information

NPI: 1609107275
Provider Name (Legal Business Name): PAUL MEJIA MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 N. LOIS AVE.
TAMPA FL
33614
US

IV. Provider business mailing address

6214 N LOIS AVE
TAMPA FL
33614-4833
US

V. Phone/Fax

Practice location:
  • Phone: 727-541-5304
  • Fax: 727-546-8527
Mailing address:
  • Phone: 718-753-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: