Provider Demographics
NPI:1922766054
Name:ADONIS, BAN'KETISHA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:BAN'KETISHA
Middle Name:
Last Name:ADONIS
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 1:15540 KENSINGTON TRL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8138
Mailing Address - Country:US
Mailing Address - Phone:407-414-6110
Mailing Address - Fax:
Practice Address - Street 1:15540 KENSINGTON TRL
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8138
Practice Address - Country:US
Practice Address - Phone:407-414-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18508224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant