MEDICARE: ODALYS CASANOLA

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	106S00000X	Behavior Technician	RBT-20-114220	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	:	1265068621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODALYS CASANOLA

Provider Business Mailing Address
First Line	:	741 NW 45TH AVE APT 22
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2467
Country	:	US
Telephone Number	:	786-253-5481
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 NW 123RD AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-3825
Country	:	US
Telephone Number	:	854-589-5697
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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Directions to “ ODALYS CASANOLA ” Practice Location

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