Provider Demographics
NPI:1568950301
Name:DRISCOLL, LUZVIMINDA SANTOS (OTA)
Entity Type:Individual
Prefix:
First Name:LUZVIMINDA
Middle Name:SANTOS
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:LUZVIMINDA
Other - Middle Name:SANTIAGO
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6802
Mailing Address - Country:US
Mailing Address - Phone:407-617-2506
Mailing Address - Fax:
Practice Address - Street 1:3355 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6062
Practice Address - Country:US
Practice Address - Phone:407-862-6263
Practice Address - Fax:407-862-4188
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12736224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant