Healthcare Provider Details

I. General information

NPI: 1679633150
Provider Name (Legal Business Name): MARIA CRISTINA GODIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 TOWN CENTER CIR
WESTON FL
33326-3637
US

IV. Provider business mailing address

4155 NW 64TH AVE
CORAL SPRINGS FL
33067-3043
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-3456
  • Fax: 954-616-1315
Mailing address:
  • Phone: 954-536-3466
  • Fax: 954-616-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: