Provider Demographics
NPI:1225377922
Name:EKLUND, TINA K (COTA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:K
Last Name:EKLUND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:K
Other - Last Name:LANDSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:9225 ALAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-2326
Mailing Address - Country:US
Mailing Address - Phone:941-637-1036
Mailing Address - Fax:
Practice Address - Street 1:991 PONDELLA RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3500
Practice Address - Country:US
Practice Address - Phone:239-995-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA3798224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant