Healthcare Provider Details

I. General information

NPI: 1275077109
Provider Name (Legal Business Name): CARMINA LAO CATRAL OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SAND LAKE RD STE 266
ORLANDO FL
32809-7748
US

IV. Provider business mailing address

4120 EVANDER DR
ORLANDO FL
32812-8141
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number15061
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number360073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: