Provider Demographics
NPI:1558513861
Name:CASUPANG, AZENITH (OTR/L)
Entity Type:Individual
Prefix:
First Name:AZENITH
Middle Name:
Last Name:CASUPANG
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 1:38921 HARBORWOODS PL
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6056
Mailing Address - Country:US
Mailing Address - Phone:443-813-9498
Mailing Address - Fax:
Practice Address - Street 1:701 LAKE PORT BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7674
Practice Address - Country:US
Practice Address - Phone:352-728-3366
Practice Address - Fax:352-435-0206
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist