Provider Demographics
NPI:1578756607
Name:DIFERDINANDO, DARLA (OTA)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:DIFERDINANDO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-6003
Mailing Address - Country:US
Mailing Address - Phone:727-346-0822
Mailing Address - Fax:727-346-0823
Practice Address - Street 1:3955 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-6003
Practice Address - Country:US
Practice Address - Phone:727-346-0822
Practice Address - Fax:727-346-0823
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10540224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant