Provider Demographics
NPI:1174836266
Name:COLOGERO, CARA M (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:M
Last Name:COLOGERO
Suffix:
Gender:F
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 1:397 PALM COAST PKWY SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4776
Mailing Address - Country:US
Mailing Address - Phone:386-793-0612
Mailing Address - Fax:386-597-2820
Practice Address - Street 1:397 PALM COAST PKWY SW
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4776
Practice Address - Country:US
Practice Address - Phone:386-793-0612
Practice Address - Fax:386-597-2820
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10770224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant