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General NPI Number Information
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NPI Number | 1841881125
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Entity Type | Individual
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Provider Name | STEPHANIE A BAVARESCO OT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 2690 SW 22ND ST # 3
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City | CORAL GABLES
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State | FL
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Zip | 33145-3406
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Country | US
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Telephone | 305-615-1628
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Fax | 305-306-9902
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Provider Business Mailing Address
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Address Line | 2690 SW 22ND ST # 3
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City | CORAL GABLES
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State | FL
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Zip | 33145-3406
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Country | US
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Telephone | 305-615-1628
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Fax | 305-306-9902
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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 | OT21091
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License Number State | FL
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