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General NPI Number Information
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NPI Number | 1881808467
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Entity Type | Individual
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Provider Name | LUCERO MORA OTR
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 454 NW 22ND AVE
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City | MIAMI
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State | FL
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Zip | 33125-3364
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Country | US
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Telephone | 305-643-6883
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Fax |
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Provider Business Mailing Address
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Address Line | 19242 SW 65TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33332-3361
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Country | US
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Telephone | 954-680-3712
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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 | OT6051
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License Number State | FL
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