Healthcare Provider Details

I. General information

NPI: 1235301557
Provider Name (Legal Business Name): DIANA MARCELA TERAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 MIAMI LAKES DR APT C17
HIALEAH FL
33014-6943
US

IV. Provider business mailing address

7231 MIAMI LAKES DR APT C17
HIALEAH FL
33014-6943
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-4453
  • Fax:
Mailing address:
  • Phone: 786-399-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: