Healthcare Provider Details

I. General information

NPI: 1831495084
Provider Name (Legal Business Name): LILI PANIAGUA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 SW 137TH AVE SUITE 242
MIAMI FL
33186-1413
US

IV. Provider business mailing address

10822 SW 146TH CT
MIAMI FL
33186-6601
US

V. Phone/Fax

Practice location:
  • Phone: 305-388-0004
  • Fax: 305-388-8009
Mailing address:
  • Phone: 786-362-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 14410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: