MEDICARE: ERIKA MALDONADO

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	224Z00000X	Occupational Therapy Assistant	OTA14815	FL

General Provider Information

NPI Number	:	1629435912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA MALDONADO

Provider Business Mailing Address
First Line	:	2577 SW 83RD AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-7411
Country	:	US
Telephone Number	:	786-712-6388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2577 SW 83RD AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-7411
Country	:	US
Telephone Number	:	786-712-6388
Fax Number	:

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

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	01/18/2016

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