MEDICARE: LISETE CARNICER

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	224Z00000X	Occupational Therapy Assistant	OTA11330	FL

General Provider Information

NPI Number	:	1033528161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETE CARNICER

Provider Business Mailing Address
First Line	:	7885 SW 158TH TER
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-2330
Country	:	US
Telephone Number	:	305-205-8011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4400
Country	:	US
Telephone Number	:	305-205-8011
Fax Number	:

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

Provider Enumeration Date	:	08/02/2014
Last Update Date	:	08/02/2014

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Directions to “ LISETE CARNICER ” Practice Location

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