Healthcare Provider Details

I. General information

NPI: 1558091132
Provider Name (Legal Business Name): LAURA OTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 SW 129TH CT STE 211
MIAMI FL
33186-4584
US

IV. Provider business mailing address

12273 SW 18TH TER
MIAMI FL
33175-7365
US

V. Phone/Fax

Practice location:
  • Phone: 305-639-8760
  • Fax: 786-953-5144
Mailing address:
  • Phone: 786-406-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-298001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: