Provider Demographics
NPI:1750752408
Name:DIAZ, LYNETTE (COTA)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3581 MOSS POINTE PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2434
Mailing Address - Country:US
Mailing Address - Phone:407-928-5600
Mailing Address - Fax:
Practice Address - Street 1:1191 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2035
Practice Address - Country:US
Practice Address - Phone:407-951-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOAT14781224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant