Provider Demographics
NPI:1649598475
Name:PASSALACQUA, SINDY ROBIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SINDY
Middle Name:ROBIN
Last Name:PASSALACQUA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SINDY
Other - Middle Name:ROBIN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5032
Mailing Address - Country:US
Mailing Address - Phone:941-722-3582
Mailing Address - Fax:941-729-8322
Practice Address - Street 1:410 10TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5032
Practice Address - Country:US
Practice Address - Phone:941-722-3582
Practice Address - Fax:941-729-8322
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14090225XP0200X, 225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002299200Medicaid