Provider Demographics
NPI:1962708040
Name:DEFELICE, RHONDA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:DEFELICE
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 1:7413 DANBURY WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7077
Mailing Address - Country:US
Mailing Address - Phone:727-432-3360
Mailing Address - Fax:
Practice Address - Street 1:7413 DANBURY WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-7077
Practice Address - Country:US
Practice Address - Phone:727-432-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8136224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant