Provider Demographics
NPI:1427423243
Name:BOORNAZIAN, ROBIN (COTA/L, CPT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BOORNAZIAN
Suffix:
Gender:F
Credentials:COTA/L, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 PICCADILLY SKY WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5756
Mailing Address - Country:US
Mailing Address - Phone:407-412-6450
Mailing Address - Fax:
Practice Address - Street 1:9660 PICCADILLY SKY WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5756
Practice Address - Country:US
Practice Address - Phone:407-412-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13660224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant