Provider Demographics
NPI:1407087463
Name:LONZO, TARA S (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:LONZO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:S
Other - Last Name:TROEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5325
Mailing Address - Country:US
Mailing Address - Phone:727-417-1329
Mailing Address - Fax:
Practice Address - Street 1:880 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4827
Practice Address - Country:US
Practice Address - Phone:727-767-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist