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General NPI Number Information
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NPI Number | 1619091071
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Entity Type | Individual
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Provider Name | JASON JOSEPH DECHRISTOFANO COTA
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7201 GREENBORO DR
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City | MELBOURNE
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State | FL
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Zip | 32904-1698
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Country | US
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Telephone | 321-727-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 695 WAYCROSS RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-3312
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Country | US
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Telephone | 321-544-3413
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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 | OTA10284
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License Number State | FL
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