Provider Demographics
NPI:1558071209
Name:LOMBARDO, ADA KEUNG (OTR)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:KEUNG
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23013 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8448
Mailing Address - Country:US
Mailing Address - Phone:941-625-1100
Mailing Address - Fax:941-613-0058
Practice Address - Street 1:23013 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8448
Practice Address - Country:US
Practice Address - Phone:941-625-1100
Practice Address - Fax:941-613-0058
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist