Individual
CAROL TIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
10521 HEARTH RD, SPRING HILL, FL 34608-3714
(352) 683-7117
(727) 845-1811
Mailing address
6325 MONTANA AVE, NEW PORT RICHEY, FL 34653-3833
(727) 809-3326
(727) 845-1811
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT1010
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10656001
CITRUS HEALTHCARE NPR
FL
01
—
10656002
CITRUS HEALTHCARE SH
FL
05
—
880317000
—
FL
Enumeration date
02/09/2007
Last updated
02/06/2019
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