Provider Demographics
NPI:1629584248
Name:COX, LAURIE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:COX
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 1:1645 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6001
Mailing Address - Country:US
Mailing Address - Phone:256-872-0167
Mailing Address - Fax:
Practice Address - Street 1:145 MIDDLE ST STE 1101
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3594
Practice Address - Country:US
Practice Address - Phone:407-985-0658
Practice Address - Fax:407-985-0658
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15390224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant