MEDICARE: MS. MONICA L DAZA OTA

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	224Z00000X	Occupational Therapy Assistant	OTA11974	FL

General Provider Information

NPI Number	:	1033480603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA L DAZA OTA

Provider Business Mailing Address
First Line	:	266 BRAVE RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-2104
Country	:	US
Telephone Number	:	305-812-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 N MAIN ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4564
Country	:	US
Telephone Number	:	407-931-1014
Fax Number	:

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

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	03/10/2026

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