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General NPI Number Information
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NPI Number | 1760076434
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Entity Type | Organization
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Legal Business Name | OTHENTIC THERAPY
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 16406 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33193-5713
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Country | US
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Telephone | 305-904-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 16406 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33193-5713
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Country | US
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Telephone | 305-904-4124
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELA FUNDORA
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Credential | COTA/L
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Telephone | 305-904-4124
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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