MEDICARE: MRS. CASSANDRA A. NABALTA 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	OT-12320	FL
2	225XP0200X	Pediatric Occupational Therapist	OT-12320	FL

General Provider Information

NPI Number	:	1417093600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA A. NABALTA MS, OTR L

Provider Business Mailing Address
First Line	:	5115 N SOCRUM LOOP RD
Second Line	:	APT 39
City	:	LAKELAND
State	:	FL
Zip	:	33809-4288
Country	:	US
Telephone Number	:	863-802-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-1974
Country	:	US
Telephone Number	:	863-802-6600
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/11/2025

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