Provider Demographics
NPI:1013599208
Name:TANGKEKO, ANDREW (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:TANGKEKO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 SATINWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8610
Mailing Address - Country:US
Mailing Address - Phone:321-203-6711
Mailing Address - Fax:
Practice Address - Street 1:244 SATINWOOD CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8610
Practice Address - Country:US
Practice Address - Phone:321-203-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18075224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant