Individual
MISS STEPHANIE MARCIA PETRA DIFORMATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7 PEYTON PL, PALM COAST, FL 32164-4744
(386) 793-3898
Mailing address
7 PEYTON PL, PALM COAST, FL 32164-4744
(386) 793-3898
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 11434
FL
Other
Enumeration date
01/14/2011
Last updated
01/14/2011
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