Healthcare Provider Details

I. General information

NPI: 1275973208
Provider Name (Legal Business Name): MILESTONES PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11395 SW 66TH ST
MIAMI FL
33173-1964
US

IV. Provider business mailing address

PO BOX 831525
MIAMI FL
33283-1525
US

V. Phone/Fax

Practice location:
  • Phone: 786-942-0719
  • Fax: 305-630-9603
Mailing address:
  • Phone: 786-942-0719
  • Fax: 305-630-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11319
License Number StateFL

VIII. Authorized Official

Name: EDITH VILORIA
Title or Position: OWNER
Credential: OTR/L
Phone: 786-942-0719