Provider Demographics
NPI:1043780505
Name:LAROSA, HOLLIS (COTA)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:LAROSA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15646 SE 89TH CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-5606
Mailing Address - Country:US
Mailing Address - Phone:321-243-2236
Mailing Address - Fax:
Practice Address - Street 1:15646 SE 89TH CT
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-5606
Practice Address - Country:US
Practice Address - Phone:321-243-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14377224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant