Provider Demographics
NPI:1518384528
Name:OLIVEIRA DRISCOLL, ROCCIA MARIA
Entity Type:Individual
Prefix:
First Name:ROCCIA
Middle Name:MARIA
Last Name:OLIVEIRA DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E BROADWAY ST # 122
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:407-792-5693
Practice Address - Street 1:1000 W BROADWAY ST FL SUITE214
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:407-792-5693
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18526225100000X
FL32342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023768200Medicaid