Individual
MRS. MARY AGNES PAVAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1904 GLEN LAKES CIR. N., THERAPY PLAYHOUSE, ST. PETERSBURG, FL 33702
(727) 423-0060
Mailing address
894 HENRICO CT, NEWPORT NEWS, VA 23608-9320
(757) 329-7420
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 10884
FL
Other
Enumeration date
05/28/2009
Last updated
05/28/2009
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