Provider Demographics
NPI:1417646498
Name:PIETROWSKI, GEORGE JOSEPH (COTA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOSEPH
Last Name:PIETROWSKI
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 1:10415 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3103
Mailing Address - Country:US
Mailing Address - Phone:727-420-0919
Mailing Address - Fax:
Practice Address - Street 1:10415 AZALEA DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3103
Practice Address - Country:US
Practice Address - Phone:727-420-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15300224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant