Provider Demographics
NPI:1962979054
Name:RAMIREZ, LIDIA B (COTA)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:B
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 EAGLE NEST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3219
Mailing Address - Country:US
Mailing Address - Phone:305-458-3223
Mailing Address - Fax:
Practice Address - Street 1:2906 EAGLE NEST VIEW DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3219
Practice Address - Country:US
Practice Address - Phone:305-458-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16807224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant