Provider Demographics
NPI:1124485222
Name:CAPPS, STACI (COTA)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:
Last Name:CAPPS
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 1:1486 SWANSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5859
Mailing Address - Country:US
Mailing Address - Phone:407-977-4448
Mailing Address - Fax:407-977-4402
Practice Address - Street 1:1486 SWANSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5859
Practice Address - Country:US
Practice Address - Phone:407-977-4448
Practice Address - Fax:407-977-4402
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10584224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA10584OtherSTATE OF FLORIDA