Provider Demographics
NPI:1871218875
Name:SFERLAZZA, MATTHEW R (COTA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:SFERLAZZA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 PLANTERS CREEK CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7660
Mailing Address - Country:US
Mailing Address - Phone:727-324-7014
Mailing Address - Fax:
Practice Address - Street 1:2595 TAMPA RD STE A
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3130
Practice Address - Country:US
Practice Address - Phone:813-812-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18693224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant