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General NPI Number Information
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NPI Number | 1013118629
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Entity Type | Individual
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Provider Name | MARTHA AZUCENA DIAZ OTR
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 W 49 ST SUITE 450
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-821-4020
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Fax | 305-821-1125
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Provider Business Mailing Address
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Address Line | 3611 SW 139 CT
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 305-227-8083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT6602
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License Number State | FL
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