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General NPI Number Information
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NPI Number | 1639557960
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Entity Type | Individual
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Provider Name | MARILYN EUSTACHE
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 18951 SW 106TH AVE
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City | CUTLER BAY
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State | FL
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Zip | 33157-7668
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Country | US
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Telephone | 305-233-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 17781 SW 112TH PL
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City | MIAMI
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State | FL
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Zip | 33157-4914
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Country | US
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Telephone |
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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 | OT17057
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License Number State | FL
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