Healthcare Provider Details

I. General information

NPI: 1922115518
Provider Name (Legal Business Name): MARIA DE LOS ANGELES JORGE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12 TH AVE
MIAMI FL
33136
US

IV. Provider business mailing address

9756 NW 51ST TERR
MIAMI FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7224
  • Fax: 305-585-6007
Mailing address:
  • Phone: 305-994-7337
  • Fax: 305-585-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1078
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: