Healthcare Provider Details

I. General information

NPI: 1942301320
Provider Name (Legal Business Name): FREDD TIRADO OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SUNSET DR STE 111
MIAMI FL
33173-5427
US

IV. Provider business mailing address

21756 STATE ROAD 54 STE 102
LUTZ FL
33549-2905
US

V. Phone/Fax

Practice location:
  • Phone: 786-507-8278
  • Fax: 786-409-2692
Mailing address:
  • Phone: 727-475-5540
  • Fax: 844-213-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: