MEDICARE: MS. ANDREA LEE MUNOZ 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	OT#10221	FL

General Provider Information

NPI Number	:	1104843754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LEE MUNOZ OTR

Provider Business Mailing Address
First Line	:	65 FLEMINGWOOD LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-9260
Country	:	US
Telephone Number	:	386-793-0612
Fax Number	:	386-447-5281

Provider Business Practice Location Address
First Line	:	8851 HAWTHORNE AVE
Second Line	:
City	:	SURFSIDE
State	:	FL
Zip	:	33154-3329
Country	:	US
Telephone Number	:	386-793-0612
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/04/2013

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