MEDICARE: DIANA MARCELA TERAN OTR/L

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
1	225X00000X	Occupational Therapist	13152	FL

General Provider Information

NPI Number	:	1235301557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARCELA TERAN OTR/L

Provider Business Mailing Address
First Line	:	7231 MIAMI LAKES DR APT C17
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-6943
Country	:	US
Telephone Number	:	786-399-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	7231 MIAMI LAKES DR APT C17
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-6943
Country	:	US
Telephone Number	:	786-399-4453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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