Individual
MARISA SOUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
129A BRUNSWICK LN, PALM COAST, FL 32137-8708
(401) 741-0470
Mailing address
129A BRUNSWICK LN, PALM COAST, FL 32137-8708
(401) 741-0470
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA12676
FL
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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