MEDICARE: FAUCHARD SAINT-HILAIRE COTA/L-CLT

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	OTA17233	FL

General Provider Information

NPI Number	:	1831853423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAUCHARD SAINT-HILAIRE COTA/L-CLT

Provider Business Mailing Address
First Line	:	901 BLACK KNIGHT DR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33594-6605
Country	:	US
Telephone Number	:	813-613-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 WALDEN WOODS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-3610
Country	:	US
Telephone Number	:	813-540-9683
Fax Number	:

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

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	10/28/2021

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Directions to “ FAUCHARD SAINT-HILAIRE COTA/L-CLT” Practice Location

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