Provider Demographics
NPI:1740618271
Name:MEDINA, NOEL ELIZABETH (COTA)
Entity Type:Individual
Prefix:MISS
First Name:NOEL
Middle Name:ELIZABETH
Last Name:MEDINA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 CABERNET CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839-3910
Mailing Address - Country:US
Mailing Address - Phone:863-651-2628
Mailing Address - Fax:
Practice Address - Street 1:701 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1671
Practice Address - Country:US
Practice Address - Phone:863-318-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12724224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant