Healthcare Provider Details

I. General information

NPI: 1891423810
Provider Name (Legal Business Name): CAROLINA CARIDAD CASTILLO OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 N FEDERAL HWY UNIT 253
POMPANO BEACH FL
33062-1036
US

IV. Provider business mailing address

6891 WINGED FOOT DR
HIALEAH FL
33015-2347
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number473694
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: