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General NPI Number Information
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NPI Number | 1972213510
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Entity Type | Individual
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Provider Name | MADELINE ELENA FEZZIE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 1513 SUN CITY CENTER PLZ
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5390
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Country | US
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Telephone | 813-634-6022
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Fax |
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Provider Business Mailing Address
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Address Line | 11528 WELLMAN DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-3765
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Country | US
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Telephone | 863-660-3801
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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 | OT23678
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License Number State | FL
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