Provider Demographics
NPI:1770773632
Name:TROTMAN, TAISHA
Entity type:Individual
Prefix:
First Name:TAISHA
Middle Name:
Last Name:TROTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 KELTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0000
Mailing Address - Country:US
Mailing Address - Phone:407-523-0300
Mailing Address - Fax:
Practice Address - Street 1:1091 KELTON AVENUE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-0000
Practice Address - Country:US
Practice Address - Phone:407-523-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10609224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant