MEDICARE: AMY STANGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT12495	FL

General Provider Information

NPI Number	:	1023260759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY STANGO

Provider Business Mailing Address
First Line	:	3430 CULLEN LAKE SHORE DR
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	215-431-3374
Fax Number	:	407-704-3088

Provider Business Practice Location Address
First Line	:	3430 CULLEN LAKE SHORE DR
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	215-431-3374
Fax Number	:	407-704-3088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	10/18/2016

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Directions to “ AMY STANGO ” Practice Location

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