Provider Demographics
NPI:1831351485
Name:DIMITRIJEVIC, FIORELLA R (OTR/L)
Entity type:Individual
Prefix:
First Name:FIORELLA
Middle Name:R
Last Name:DIMITRIJEVIC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:FIORELLA
Other - Middle Name:
Other - Last Name:TAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3822 BAYSHORE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5518
Mailing Address - Country:US
Mailing Address - Phone:913-579-9693
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVENUE N
Practice Address - Street 2:STE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5027
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01997225X00000X
FLOT13419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist