MEDICARE: MS. ANGELINA AVANESOVA OT

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	OT26659	FL

General Provider Information

NPI Number	:	1235656232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELINA AVANESOVA OT

Provider Business Mailing Address
First Line	:	PO BOX 290370
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33329-0370
Country	:	US
Telephone Number	:	954-262-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 COLLEGE AVE RM 1441
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7721
Country	:	US
Telephone Number	:	954-262-4100
Fax Number	:

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

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	05/05/2026

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