Provider Demographics
NPI:1619233111
Name:PALACIOS, CLAUDIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 BRIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4867
Mailing Address - Country:US
Mailing Address - Phone:813-480-7483
Mailing Address - Fax:
Practice Address - Street 1:6320 BRIDGECREST DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4867
Practice Address - Country:US
Practice Address - Phone:813-480-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OTA 10351224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant