Individual
DIANE DECOSTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4101 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
(904) 296-6800
Mailing address
4101 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 10886
FL
Other
Enumeration date
02/03/2013
Last updated
02/03/2013
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