Healthcare Provider Details

I. General information

NPI: 1598399198
Provider Name (Legal Business Name): CORTNI LQUAIN TOWNSEND OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 NE 7TH ST
TRENTON FL
32693-3636
US

IV. Provider business mailing address

8477 S SUNCOAST BLVD
HOMOSASSA FL
34446-5028
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-7101
  • Fax:
Mailing address:
  • Phone: 352-382-7214
  • Fax: 352-382-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA15166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: