Healthcare Provider Details

I. General information

NPI: 1639497704
Provider Name (Legal Business Name): SANTIAGO RESTREPO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

IV. Provider business mailing address

1031 N 16TH AVE
HOLLYWOOD FL
33020-3736
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-1881
  • Fax: 954-603-5341
Mailing address:
  • Phone: 954-600-8328
  • Fax: 954-374-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: