Healthcare Provider Details

I. General information

NPI: 1124744305
Provider Name (Legal Business Name): KAROL ACOSTA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 N SEMORAN BLVD
WINTER PARK FL
32792-2840
US

IV. Provider business mailing address

2135 CASCADES COVE DR
ORLANDO FL
32820-2250
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-1515
  • Fax:
Mailing address:
  • Phone: 407-619-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT0003404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: