Provider Demographics
NPI:1205317948
Name:CICCONE, PATRICIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CICCONE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SALT MEADOW CIR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1799
Mailing Address - Country:US
Mailing Address - Phone:813-841-9458
Mailing Address - Fax:
Practice Address - Street 1:231 COURTYARD BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5759
Practice Address - Country:US
Practice Address - Phone:813-642-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist