Provider Demographics
NPI:1831853423
Name:SAINT-HILAIRE, FAUCHARD (COTA/L-CLT)
Entity type:Individual
Prefix:
First Name:FAUCHARD
Middle Name:
Last Name:SAINT-HILAIRE
Suffix:
Gender:M
Credentials:COTA/L-CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BLACK KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6605
Mailing Address - Country:US
Mailing Address - Phone:813-613-8423
Mailing Address - Fax:
Practice Address - Street 1:2051 WALDEN WOODS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3610
Practice Address - Country:US
Practice Address - Phone:813-540-9683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA17233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant