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NPI Code Detail

MEDICARE: ANTONIO MALDONADO OTA

MEDICARE: ANTONIO MALDONADO OTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant2012026727MO

General Provider Information

NPI Number : 1205209939
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO MALDONADO OTA
Provider Business Mailing Address
First Line : 2017 W WOODLAND ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5913
Country : US
Telephone Number : 417-889-4800
Fax Number :
Provider Business Practice Location Address
First Line : 2017 W WOODLAND ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5913
Country : US
Telephone Number : 417-889-4800
Fax Number : 417-889-0980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2015
Last Update Date : 11/03/2015

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Directions to “ ANTONIO MALDONADO OTA” Practice Location

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