MEDICARE: TARA SUSANNE LONZO MS, OTR/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	225X00000X	Occupational Therapist	OT13655	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407087463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA SUSANNE LONZO MS, OTR/L

Provider Business Mailing Address
First Line	:	5700 3RD ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33705-5325
Country	:	US
Telephone Number	:	727-417-1329
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 E STATE ROAD 64
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-9041
Country	:	US
Telephone Number	:	941-745-5111
Fax Number	:

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	06/19/2026

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