Basic Information
| Provider Information | |||||||||
| NPI: | 1568950301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRISCOLL | ||||||||
| FirstName: | LUZVIMINDA | ||||||||
| MiddleName: | SANTOS | ||||||||
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| Credential: | OTA | ||||||||
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| OtherLastName: | SANTOS | ||||||||
| OtherFirstName: | LUZVIMINDA | ||||||||
| OtherMiddleName: | SANTIAGO | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 624 BURKE ST | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327016802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076172506 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3355 E SEMORAN BLVD | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327036062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078626263 | ||||||||
| FaxNumber: | 4078624188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2018 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 12736 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.