MEDICARE: ELIANY PADRON DOMINGUEZ OTR/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	OT23824	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194225359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIANY PADRON DOMINGUEZ OTR/L

Provider Business Mailing Address
First Line	:	4960 SW 72ND AVE STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5549
Country	:	US
Telephone Number	:	305-461-4702
Fax Number	:	305-461-4705

Provider Business Practice Location Address
First Line	:	4960 SW 72ND AVE STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5549
Country	:	US
Telephone Number	:	305-461-4702
Fax Number	:

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

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	01/11/2024

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Directions to “ ELIANY PADRON DOMINGUEZ OTR/L” Practice Location

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