Provider Demographics
NPI:1467958728
Name:DEGENNARO, NICOLE DANIELLE KOZEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE KOZEE
Last Name:DEGENNARO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 HICKORY TREE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8412
Mailing Address - Country:US
Mailing Address - Phone:813-394-9808
Mailing Address - Fax:
Practice Address - Street 1:578 OCOEE COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4219
Practice Address - Country:US
Practice Address - Phone:407-656-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist