Healthcare Provider Details

I. General information

NPI: 1639705809
Provider Name (Legal Business Name): ANDREA MARIA LLANO MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 NW 15TH ST APT 304
MIAMI FL
33136-1431
US

IV. Provider business mailing address

750 NW 15TH ST
MIAMI FL
33136-1431
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-1818
  • Fax:
Mailing address:
  • Phone: 305-325-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: