Provider Demographics
NPI:1215477831
Name:CUCINELLA, ANGELA (COTA/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CUCINELLA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2360 SW PETTIS SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2360 SW PETTIS SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3418
Practice Address - Country:US
Practice Address - Phone:850-591-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15774224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15774OtherCOTA LICENSE NUMBER