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General NPI Number Information
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NPI Number | 1558635946
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Entity Type | Individual
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Provider Name | STACY A MCDONALD COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 1820 SHORE DR S
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4601
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Country | US
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Telephone | 727-851-9806
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66724
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City | ST PETE BEACH
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State | FL
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Zip | 33736-6724
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Country | US
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Telephone | 386-852-8210
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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 | OTA12159
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License Number State | FL
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