MEDICARE: ILEANA PENA

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	OT 11881	FL

General Provider Information

NPI Number	:	1669657854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA PENA

Provider Business Mailing Address
First Line	:	232 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5260
Country	:	US
Telephone Number	:	305-882-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5260
Country	:	US
Telephone Number	:	305-882-0615
Fax Number	:

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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Directions to “ ILEANA PENA ” Practice Location

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