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General NPI Number Information
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NPI Number | 1295057776
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Entity Type | Individual
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Provider Name | ANGIE LISSETTE BOLANOS-ESCALONA OTR
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Gender | Female
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 04/23/2017
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Provider Practice Location Address
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Address Line | 1401 E 4TH AVE STE 204
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City | HIALEAH
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State | FL
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Zip | 33010-3504
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Country | US
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Telephone | 786-348-6361
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Fax | 866-665-8671
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Provider Business Mailing Address
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Address Line | 15751 SHERIDAN ST STE 162
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City | FORT LAUDERDALE
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State | FL
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Zip | 33331-3486
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Country | US
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Telephone | 786-348-6361
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Fax | 866-665-8671
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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 | 9463
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License Number State | FL
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