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General NPI Number Information
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NPI Number | 1013484195
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Entity Type | Individual
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Provider Name | PATRYCJA ATAIDES OTA
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Gender | Female
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Dates
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Enumeration Date | 10/27/2018
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Last Update Date | 10/27/2018
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Provider Practice Location Address
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Address Line | 13420 SW 314TH ST STE 169
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City | HOMESTEAD
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State | FL
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Zip | 33033-5541
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Country | US
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Telephone | 786-380-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 12080 SW 268TH ST UNIT 29
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City | HOMESTEAD
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State | FL
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Zip | 33032-8170
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Country | US
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Telephone | 786-380-9520
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA14910
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License Number State | FL
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