Provider Demographics
NPI:1104495662
Name:DUCLAUD, ANA PAULA IV (COTA)
Entity type:Individual
Prefix:
First Name:ANA PAULA
Middle Name:
Last Name:DUCLAUD
Suffix:IV
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11239 NW 53RD LN # ON
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3511
Mailing Address - Country:US
Mailing Address - Phone:786-253-7817
Mailing Address - Fax:
Practice Address - Street 1:11239 NW 53RD LN
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3511
Practice Address - Country:US
Practice Address - Phone:786-253-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16859224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant