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NPI Code Detail

MEDICARE: MRS. MARTHA LILIANA HENAO

MEDICARE: MRS. MARTHA LILIANA HENAO
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1275925588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARTHA LILIANA HENAO
Provider Business Mailing Address
First Line : 9629 ORANGE GROVE DR
Second Line :
City : TAMPA
State : FL
Zip : 33618-4513
Country : US
Telephone Number : 407-864-0820
Fax Number :
Provider Business Practice Location Address
First Line : 447 BELLA VIDA BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32828-6717
Country : US
Telephone Number : 321-961-3489
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2015
Last Update Date : 02/23/2015

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