MEDICARE: ALMA FAJARDO 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	225X00000X	Occupational Therapist	OT14891	FL

General Provider Information

NPI Number	:	1356822548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALMA FAJARDO OTR

Provider Business Mailing Address
First Line	:	9454 OXFORD DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-4845
Country	:	US
Telephone Number	:	404-422-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 N SCENIC HWY
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-3208
Country	:	US
Telephone Number	:	863-676-1512
Fax Number	:

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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Directions to “ ALMA FAJARDO OTR” Practice Location

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