Healthcare Provider Details

I. General information

NPI: 1881808467
Provider Name (Legal Business Name): LUCERO MORA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 NW 22ND AVE
MIAMI FL
33125-3364
US

IV. Provider business mailing address

18862 NW 24TH CT
PEMBROKE PINES FL
33029-5354
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-6883
  • Fax:
Mailing address:
  • Phone: 954-993-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT6051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: