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NPI Code Detail

MEDICARE: DESTINY THOMPSON COTA/L

MEDICARE: DESTINY THOMPSON 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
1224Z00000XOccupational Therapy AssistantOTA19828FL

General Provider Information

NPI Number : 1235981911
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY THOMPSON COTA/L
Provider Business Mailing Address
First Line : 22391 FLORA PARKE XING UNIT A
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-8005
Country : US
Telephone Number : 904-321-9054
Fax Number : 855-565-1769
Provider Business Practice Location Address
First Line : 22391 FLORA PARKE XING UNIT A
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-8005
Country : US
Telephone Number : 904-321-9054
Fax Number : 855-565-1769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2024
Last Update Date : 04/04/2024

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Directions to “ DESTINY THOMPSON COTA/L” Practice Location

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