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General NPI Number Information
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NPI Number | 1346588050
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Entity Type | Individual
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Provider Name | SANDRA DEROSSO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 8417 OLD COUNTY ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6418
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Country | US
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Telephone | 727-376-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 11012 CASA GRANDE CIR
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City | SPRING HILL
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State | FL
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Zip | 34608-8404
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Country | US
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Telephone | 352-428-0234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA3981
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License Number State | FL
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