MEDICARE: MR. MARIO PAJARILLAGA STA MARIA JR. 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	OT01111	RI
2	225X00000X	Occupational Therapist	OT13283	FL

General Provider Information

NPI Number	:	1427174077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO PAJARILLAGA STA MARIA JR. OT

Provider Business Mailing Address
First Line	:	9416 AZALEA RIDGE WAY
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5064
Country	:	US
Telephone Number	:	407-505-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 MOORE RD
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-4704
Country	:	US
Telephone Number	:	407-697-0969
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/26/2021

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