Healthcare Provider Details

I. General information

NPI: 1689723769
Provider Name (Legal Business Name): MONICA RAQUEL PHILLIPS OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 N KENDALL DR SUITE 102
MIAMI FL
33176-1978
US

IV. Provider business mailing address

10350 SW 137TH CT
MIAMI FL
33186-6810
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-5458
  • Fax: 786-924-6336
Mailing address:
  • Phone: 305-408-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 11243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: