Provider Demographics
NPI:1386983336
Name:HARTWIGS, MARIA TERESA (COTAL)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TERESA
Last Name:HARTWIGS
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:TERESA
Other - Last Name:HARTWIGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTAL
Mailing Address - Street 1:389 WISHING WELL CIR SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6419
Mailing Address - Country:US
Mailing Address - Phone:321-795-5337
Mailing Address - Fax:
Practice Address - Street 1:389 WISHIG WELL CIRCLE SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-6419
Practice Address - Country:US
Practice Address - Phone:321-795-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9545224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant