Provider Demographics
NPI:1174095608
Name:RICCA, SARAH SHEPARD (OTR/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SHEPARD
Last Name:RICCA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5907 ARGERIAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4237
Mailing Address - Country:US
Mailing Address - Phone:813-907-0548
Mailing Address - Fax:
Practice Address - Street 1:2352 BRUCE B DOWNS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9203
Practice Address - Country:US
Practice Address - Phone:813-751-3373
Practice Address - Fax:813-377-1697
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist