Provider Demographics
NPI:1376047530
Name:DASH, NATHANIEL EDWARD (COTA)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:EDWARD
Last Name:DASH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 TANGLEWOOD BAY DR APT 1105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7344
Mailing Address - Country:US
Mailing Address - Phone:407-625-3436
Mailing Address - Fax:
Practice Address - Street 1:6627 TANGLEWOOD BAY DR
Practice Address - Street 2:APT 1105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-3282
Practice Address - Country:US
Practice Address - Phone:407-625-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15862224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant