Provider Demographics
NPI:1235599705
Name:CORDOBA, LEIDY J (COTA/L)
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:J
Last Name:CORDOBA
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 1:2615 DOVER GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7523
Mailing Address - Country:US
Mailing Address - Phone:407-970-0824
Mailing Address - Fax:321-235-5506
Practice Address - Street 1:2615 DOVER GLEN CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7523
Practice Address - Country:US
Practice Address - Phone:407-970-0824
Practice Address - Fax:321-235-5506
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14981224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant