Provider Demographics
NPI:1326790585
Name:CAMPOS, PAULA ROBERTA (OTA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ROBERTA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 LUTHER RD APT 512
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-2679
Mailing Address - Country:US
Mailing Address - Phone:941-246-1154
Mailing Address - Fax:
Practice Address - Street 1:2511 LUTHER RD APT 512
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-2679
Practice Address - Country:US
Practice Address - Phone:941-246-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15802224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant