Provider Demographics
NPI:1932652690
Name:PRATER, NICHOLAS BRANDON (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:BRANDON
Last Name:PRATER
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Gender:M
Credentials:COTA/L
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Mailing Address - Street 1:1809 E BROADWAY ST
Mailing Address - Street 2:#122
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:407-792-5693
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:STE #214
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:407-792-5693
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOTA 15403224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant