Provider Demographics
NPI:1619547809
Name:SNYDER, NANCY (COTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BAZIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3726 OAK COVE PL
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4115
Mailing Address - Country:US
Mailing Address - Phone:386-547-7377
Mailing Address - Fax:
Practice Address - Street 1:3926 OAK COVE LANE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129
Practice Address - Country:US
Practice Address - Phone:386-547-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA37184224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant