Healthcare Provider Details

I. General information

NPI: 1114584182
Provider Name (Legal Business Name): DAYAMI REPETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 WESTWARD DR STE 108109
MIAMI SPRINGS FL
33166-5290
US

IV. Provider business mailing address

1311 W 44TH ST APT C
HIALEAH FL
33012-5952
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-5176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: