Healthcare Provider Details

I. General information

NPI: 1821476953
Provider Name (Legal Business Name): VIVA THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 NW 22ND AVE STE 108
MIAMI FL
33125-3355
US

IV. Provider business mailing address

60 NW 37TH AVE APT 501
MIAMI FL
33125-4834
US

V. Phone/Fax

Practice location:
  • Phone: 305-890-9691
  • Fax: 305-647-6127
Mailing address:
  • Phone: 305-890-9691
  • Fax: 305-647-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT5689
License Number StateFL

VIII. Authorized Official

Name: VIRGINIA PACHECO
Title or Position: OWNER
Credential: OTR/L
Phone: 305-890-9691