Healthcare Provider Details

I. General information

NPI: 1386302677
Provider Name (Legal Business Name): JESSICA BAUTA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SENDIN OTR/L

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE STE 101
MIAMI FL
33193-5827
US

IV. Provider business mailing address

10457 SW 80TH ST
MIAMI FL
33173-2913
US

V. Phone/Fax

Practice location:
  • Phone: 305-388-0004
  • Fax:
Mailing address:
  • Phone: 786-294-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT22570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: