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NPI Code Detail

MEDICARE: LAUREN CHRISTINE D'AZZO COTA/L

MEDICARE: LAUREN CHRISTINE D'AZZO 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 AssistantOTA15775FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RET824478470OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1790253292
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN CHRISTINE D'AZZO COTA/L
Provider Business Mailing Address
First Line : 14904 ABAIR ST
Second Line :
City : HUDSON
State : FL
Zip : 34667-4248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1114 CHATMAN BLVD
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3104
Country : US
Telephone Number : 352-796-6701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 11/02/2018

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Directions to “ LAUREN CHRISTINE D'AZZO COTA/L” Practice Location

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