Provider Demographics
NPI:1619271673
Name:BAZZO, CHESSIE PRYOR (OT)
Entity Type:Individual
Prefix:
First Name:CHESSIE
Middle Name:PRYOR
Last Name:BAZZO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHESSIE
Other - Middle Name:FRANCIS
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:3650 N ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8655
Mailing Address - Country:US
Mailing Address - Phone:941-681-2064
Mailing Address - Fax:
Practice Address - Street 1:100 MADRID BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7968
Practice Address - Country:US
Practice Address - Phone:941-681-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14398225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist