Individual
LAUREN CHRISTINE D'AZZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1114 CHATMAN BLVD, BROOKSVILLE, FL 34601-3104
(352) 796-6701
Mailing address
14904 ABAIR ST, HUDSON, FL 34667-4248
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15775
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RET824478470
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/02/2018
Last updated
11/02/2018
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