MEDICARE: MR. HAZIEL ELIO CASTILLO OT

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	21732	FL

General Provider Information

NPI Number	:	1679875702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAZIEL ELIO CASTILLO OT

Provider Business Mailing Address
First Line	:	4508 JAMAICA STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614
Country	:	US
Telephone Number	:	813-965-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4508 JAMAICA STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614
Country	:	US
Telephone Number	:	813-447-0479
Fax Number	:

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	03/16/2022

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