Provider Demographics
NPI:1912365842
Name:DAZIO, VANESSA M (DOT)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:M
Last Name:DAZIO
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 REGENCY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5023
Mailing Address - Country:US
Mailing Address - Phone:727-848-8434
Mailing Address - Fax:
Practice Address - Street 1:9330 REGENCY PARK BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5023
Practice Address - Country:US
Practice Address - Phone:727-848-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist