Provider Demographics
NPI:1083931893
Name:OTTOBRE, PATTY ANNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:ANNE
Last Name:OTTOBRE
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 1:3126 MEADOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1487
Mailing Address - Country:US
Mailing Address - Phone:252-562-1171
Mailing Address - Fax:
Practice Address - Street 1:1026 ALBEE FARM RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6213
Practice Address - Country:US
Practice Address - Phone:941-484-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7288224Z00000X
MO004877224Z00000X
FLOTA18458224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant