Provider Demographics
NPI:1609423466
Name:MCLEROY, TASHA LOUISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:LOUISE
Last Name:MCLEROY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:LOUISE
Other - Last Name:ABSHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2473
Mailing Address - Country:US
Mailing Address - Phone:407-552-9994
Mailing Address - Fax:
Practice Address - Street 1:535 CROCKETT BLVD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-5018
Practice Address - Country:US
Practice Address - Phone:321-454-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12343224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant