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General NPI Number Information
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NPI Number | 1609691849
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Entity Type | Individual
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Provider Name | PAUL PONCE LLANOS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 13000 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33612-4745
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Country | US
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Telephone | 813-972-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 15635 INDIAN QUEEN DR
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City | ODESSA
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State | FL
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Zip | 33556-3012
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Country | US
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Telephone | 813-391-6059
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT4450
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License Number State | FL
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