MEDICARE: MRS. SHARON M LAZENBY 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
1	224Z00000X	Occupational Therapy Assistant	OTA359	FL

General Provider Information

NPI Number	:	1821204975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON M LAZENBY COTA/L

Provider Business Mailing Address
First Line	:	10506 RIVERSIDE RD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-5128
Country	:	US
Telephone Number	:	941-704-8451
Fax Number	:	941-807-0876

Provider Business Practice Location Address
First Line	:	10506 RIVERSIDE RD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-5128
Country	:	US
Telephone Number	:	941-704-8451
Fax Number	:	941-870-0876

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/22/2015

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