Healthcare Provider Details

I. General information

NPI: 1366988487
Provider Name (Legal Business Name): JAVIER GARCIA OTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 CORAL WAY
MIAMI FL
33155-1401
US

IV. Provider business mailing address

7223 CORAL WAY
MIAMI FL
33155-1401
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-0470
  • Fax: 305-264-5540
Mailing address:
  • Phone: 305-264-0470
  • Fax: 305-264-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA13594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: