Healthcare Provider Details

I. General information

NPI: 1124845458
Provider Name (Legal Business Name): VIVIAN TAMARA NUNEZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE
HIALEAH FL
33015-3664
US

IV. Provider business mailing address

4925 SW 144TH AVE
MIAMI FL
33175-5062
US

V. Phone/Fax

Practice location:
  • Phone: 305-440-0785
  • Fax:
Mailing address:
  • Phone: 305-316-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: