Provider Demographics
NPI:1023277449
Name:PEZZINO, SANDRA LEE (COTA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:PEZZINO
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 1:16104 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6334
Mailing Address - Country:US
Mailing Address - Phone:561-743-5647
Mailing Address - Fax:
Practice Address - Street 1:16104 ROBIN WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-6334
Practice Address - Country:US
Practice Address - Phone:561-743-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA538224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant