Healthcare Provider Details

I. General information

NPI: 1437835816
Provider Name (Legal Business Name): JAHNELL RIJO TRAVIESO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR STE 502
DAVIE FL
33330-4306
US

IV. Provider business mailing address

11750 CANAL ST UNIT 407
MIRAMAR FL
33025-7950
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax:
Mailing address:
  • Phone: 786-973-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: