Provider Demographics
NPI:1568026474
Name:TAQUECHEL, CYNTHIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TAQUECHEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:TAQUECHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:27571 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8297
Mailing Address - Country:US
Mailing Address - Phone:786-282-4392
Mailing Address - Fax:
Practice Address - Street 1:27571 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8297
Practice Address - Country:US
Practice Address - Phone:786-282-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14066224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant