Provider Demographics
NPI:1114404290
Name:HART, CELIA (COTA)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:HART
Suffix:
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 1:296 SE SAINT LUCIE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-1383
Mailing Address - Country:US
Mailing Address - Phone:772-634-6368
Mailing Address - Fax:
Practice Address - Street 1:279 NW CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2505
Practice Address - Country:US
Practice Address - Phone:772-301-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16446224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant