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General NPI Number Information
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NPI Number | 1104161090
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Entity Type | Individual
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Provider Name | MARISELY PACHECO ORTA MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 11602 LAKE UNDERHILL RD STE 129
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City | ORLANDO
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State | FL
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Zip | 32825-4460
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Country | US
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Telephone | 407-277-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 GAMMAGE PT
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City | OVIEDO
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State | FL
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Zip | 32765-7069
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Country | US
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Telephone | 407-488-5349
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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 | OT18324
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License Number State | FL
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