MEDICARE: AMANDA LYNN CERI OTA

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	OTA19702	FL

General Provider Information

NPI Number	:	1457124034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN CERI OTA

Provider Business Mailing Address
First Line	:	2962 LEBA LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-6516
Country	:	US
Telephone Number	:	407-690-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 LEBA LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-6516
Country	:	US
Telephone Number	:	407-690-9402
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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