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General NPI Number Information
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NPI Number | 1770976805
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Entity Type | Organization
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Legal Business Name | DANIEL BOLEA
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 13343 SW 103RD PL
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City | MIAMI
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State | FL
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Zip | 33176-6079
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Country | US
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Telephone | 305-951-7763
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Fax |
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Provider Business Mailing Address
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Address Line | 13343 SW 103RD PL
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City | MIAMI
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State | FL
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Zip | 33176-6079
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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 | OCCUPATIONAL THERAPIST/OWNER
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Name | DANIEL BOLEA
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Credential |
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Telephone | 305-951-7763
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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 | OT16878
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License Number State | FL
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