MEDICARE: MARISEL MUNOZ MSOTR/L

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	OT10167	FL

General Provider Information

NPI Number	:	1174988737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISEL MUNOZ MSOTR/L

Provider Business Mailing Address
First Line	:	9597 EL CLAIR RANCH RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3341
Country	:	US
Telephone Number	:	561-317-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	9597 EL CLAIR RANCH RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3341
Country	:	US
Telephone Number	:	561-317-0484
Fax Number	:

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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