Healthcare Provider Details

I. General information

NPI: 1942251582
Provider Name (Legal Business Name): NATASHA BRAVO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 SW 3RD AVE APT 7E
MIAMI FL
33129-2762
US

IV. Provider business mailing address

2950 SW 3RD AVE APT 7E
MIAMI FL
33129-2762
US

V. Phone/Fax

Practice location:
  • Phone: 305-801-7756
  • Fax:
Mailing address:
  • Phone: 305-801-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 6208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: