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General NPI Number Information
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NPI Number | 1700293032
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Entity Type | Individual
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Provider Name | LISANDRA PEREZ OTA
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Gender | Female
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 12741 SW 17TH CT
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City | MIRAMAR
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State | FL
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Zip | 33027-2500
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Country | US
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Telephone | 954-447-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 17800 NW 73RD AVE APT 103
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City | HIALEAH
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State | FL
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Zip | 33015-6217
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Country | US
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Telephone | 786-239-1310
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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 | OTA 12116
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License Number State | FL
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