Provider Demographics
NPI:1932779162
Name:PROFFITT, ASTRID CAROLINA
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:CAROLINA
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12242 GOTHIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6834
Mailing Address - Country:US
Mailing Address - Phone:727-459-2827
Mailing Address - Fax:
Practice Address - Street 1:7045 EVERGREEN WOODS TRL
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-1306
Practice Address - Country:US
Practice Address - Phone:352-596-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16606224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant