MEDICARE: BIANCA ELENA SOUKOVA JEAN 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	OTA16579	FL

General Provider Information

NPI Number	:	1891659595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA ELENA SOUKOVA JEAN OTA

Provider Business Mailing Address
First Line	:	2630 PLEDGE RD APT 203
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7875
Country	:	US
Telephone Number	:	786-419-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	3227 HILLSDALE LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7561
Country	:	US
Telephone Number	:	407-990-2847
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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