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NPI Code Detail

MEDICARE: JOHN J POQUETTE COTA/L

MEDICARE: JOHN J POQUETTE 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 Assistant16132FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10TA-16132OTHERFLFL OTA LICENCE

General Provider Information

NPI Number : 1255958260
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN J POQUETTE COTA/L
Provider Business Mailing Address
First Line : 3891 STIRLING RD
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33312-6216
Country : US
Telephone Number : 623-910-8930
Fax Number :
Provider Business Practice Location Address
First Line : 3891 STIRLING RD
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33312-6216
Country : US
Telephone Number : 623-910-8930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2020
Last Update Date : 06/25/2020

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