Individual
RICO DATTOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1213 CHEB PL NW, PALM BAY, FL 32907-1015
(321) 508-8665
Mailing address
1213 CHEB PL NW, PALM BAY, FL 32907-1015
(321) 508-8665
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA 11309
FL
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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