Provider Demographics
NPI:1407416381
Name:LAQUATRA, MARY FRANCES (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:LAQUATRA
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 1:10921 SW DUNHILL CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2403
Mailing Address - Country:US
Mailing Address - Phone:561-345-1064
Mailing Address - Fax:
Practice Address - Street 1:8461 LAKE WORTH RD STE 115
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2474
Practice Address - Country:US
Practice Address - Phone:561-345-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11752224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant