MEDICARE: EUGENE QUIAMBAO 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	225XP0200X	Pediatric Occupational Therapist	0006931	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	:	1235245093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE QUIAMBAO OTR

Provider Business Mailing Address
First Line	:	9436 AZALEA RIDGE WAY
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5064
Country	:	US
Telephone Number	:	407-523-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	9436 AZALEA RIDGE WAY
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5064
Country	:	US
Telephone Number	:	407-523-6987
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/27/2011

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