Individual
MISS LEIA M CAROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1615 PASADENA AVE S STE 150, SOUTH PASADENA, FL 33707-4517
(813) 558-6044
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0915
(813) 978-9700
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT11130
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10638901
CITRUS HLC
FL
01
—
2047X
BCBS
FL
05
—
888917100
—
FL
Enumeration date
01/11/2007
Last updated
09/26/2023
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