Healthcare Provider Details

I. General information

NPI: 1730245242
Provider Name (Legal Business Name): LINDA CHAVES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 METROWEST BLVD 306
ORLANDO FL
32811-2461
US

IV. Provider business mailing address

5560 METROWEST BLVD APT 306
ORLANDO FL
32811-2461
US

V. Phone/Fax

Practice location:
  • Phone: 347-263-0950
  • Fax:
Mailing address:
  • Phone: 347-263-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOT12576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: