Provider Demographics
NPI:1497086078
Name:FITZPATRICK, TERI A (COTA/L)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:A
Last Name:FITZPATRICK
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 1:1543 NW SPRUCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9523
Mailing Address - Country:US
Mailing Address - Phone:772-692-7798
Mailing Address - Fax:
Practice Address - Street 1:1543 NW SPRUCE RIDGE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9523
Practice Address - Country:US
Practice Address - Phone:772-692-7798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant