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General NPI Number Information
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NPI Number | 1609423466
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Entity Type | Individual
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Provider Name | TASHA LOUISE MCLEROY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 535 CROCKETT BLVD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-5018
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Country | US
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Telephone | 321-454-2363
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Fax |
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Provider Business Mailing Address
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Address Line | 701 CYPRESS AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-2473
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Country | US
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Telephone | 407-552-9994
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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 | OTA12343
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License Number State | FL
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