Provider Demographics
NPI:1538430608
Name:PUDOKA, DENNIS ROBERT (COTA/L)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ROBERT
Last Name:PUDOKA
Suffix:
Gender:M
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 1:1423 CALADESI DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6663
Mailing Address - Country:US
Mailing Address - Phone:330-475-4557
Mailing Address - Fax:813-406-4119
Practice Address - Street 1:518 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3419
Practice Address - Country:US
Practice Address - Phone:813-265-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant