Provider Demographics
NPI:1063935914
Name:CASTILLO, MIGUEL A JR (COTA)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:CASTILLO
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WOODGLEN CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6786
Mailing Address - Country:US
Mailing Address - Phone:304-904-0875
Mailing Address - Fax:
Practice Address - Street 1:1922 LAKE ROBERTS LANDING DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5579
Practice Address - Country:US
Practice Address - Phone:407-917-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16053224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant