MEDICARE: MS. LICED VAZQUEZ OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	10836	FL

General Provider Information

NPI Number	:	1003983248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LICED VAZQUEZ OTR

Provider Business Mailing Address
First Line	:	1350 SW 75TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4422
Country	:	US
Telephone Number	:	305-300-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 SW 75TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4422
Country	:	US
Telephone Number	:	305-300-1904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/22/2013

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