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General NPI Number Information
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NPI Number | 1265021992
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Entity Type | Individual
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Provider Name | KRISTIAN CARLOS LLACA OTD,OTR/L, ATP,CSRS
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Gender | Male
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 1239 NW 166TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1345
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Country | US
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Telephone | 305-431-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 NW 166TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1345
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Country | US
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Telephone | 305-431-0887
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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 | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number | OT16273
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number | OT16273
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225XE1200X
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Taxonomy Name | Ergonomics Occupational Therapist
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License Number | OT16273
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT16273
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | OT16273
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License Number State | FL
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