Healthcare Provider Details

I. General information

NPI: 1023605698
Provider Name (Legal Business Name): LEISY MORALES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 W OKEECHOBEE RD
HIALEAH FL
33016-2109
US

IV. Provider business mailing address

20319 NW 52ND AVE
MIAMI GARDENS FL
33055-6613
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-9900
  • Fax:
Mailing address:
  • Phone: 786-600-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: