Provider Demographics
NPI:1275294654
Name:JUSINO CAMACHO, PAOLA JUDITH (COTA/L)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:JUDITH
Last Name:JUSINO CAMACHO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 ANGUS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5826
Mailing Address - Country:US
Mailing Address - Phone:407-520-1681
Mailing Address - Fax:
Practice Address - Street 1:6343 ANGUS VALLEY DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-5826
Practice Address - Country:US
Practice Address - Phone:407-520-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18652224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant