MEDICARE: MRS. NAOMI M STIWICH COTA/L

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	OTA6832	FL

General Provider Information

NPI Number	:	1124217922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAOMI M STIWICH COTA/L

Provider Business Mailing Address
First Line	:	5715 CANTOR AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34291-5620
Country	:	US
Telephone Number	:	941-240-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 CANTOR AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34291-5620
Country	:	US
Telephone Number	:	941-240-6251
Fax Number	:

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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