Healthcare Provider Details

I. General information

NPI: 1356254585
Provider Name (Legal Business Name): CARLEE ANN COPLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 US HIGHWAY 41 BYP N
VENICE FL
34285-6091
US

IV. Provider business mailing address

9718 GULFSTREAM BLVD
ENGLEWOOD FL
34224-9258
US

V. Phone/Fax

Practice location:
  • Phone: 941-375-9813
  • Fax:
Mailing address:
  • Phone: 734-748-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number20320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: