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General NPI Number Information
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NPI Number | 1881062057
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Entity Type | Individual
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Provider Name | ANNA DAVIDOVICS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 12124 HIGH TECH AVE SUITE 400
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City | ORLANDO
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State | FL
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Zip | 32817-8373
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Country | US
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Telephone | 180-077-4778
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Fax |
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Provider Business Mailing Address
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Address Line | 12321 W LANCASTER RD
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City | HANNA CITY
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State | IL
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Zip | 61536-9674
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Country | US
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Telephone | 309-573-2040
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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 | 213094
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License Number State | TX
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