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General NPI Number Information
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NPI Number | 1467150557
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Entity Type | Individual
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Provider Name | ALICIA SHABAZZ
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 2939 LANDOVER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34608-7258
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Country | US
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Telephone | 813-751-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 14800 COYOTE RD
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City | HUDSON
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State | FL
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Zip | 34669-1100
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Country | US
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Telephone | 813-751-6221
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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 | OTA13218
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License Number State | FL
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