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NPI Code Detail

MEDICARE: KINGA MIRANDA OTR/L

MEDICARE: KINGA MIRANDA OTR/L
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
1225X00000XOccupational Therapist3538AZ
2225X00000XOccupational Therapist10-0070NV

General Provider Information

NPI Number : 1508161340
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINGA MIRANDA OTR/L
Provider Business Mailing Address
First Line : 2152 TUMBLEWEED DR
Second Line :
City : MOHAVE VALLEY
State : AZ
Zip : 86440-8945
Country : US
Telephone Number : 928-770-5026
Fax Number :
Provider Business Practice Location Address
First Line : 2812 SILVER CREEK RD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-8309
Country : US
Telephone Number : 928-763-1404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2011
Last Update Date : 01/25/2011

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Directions to “ KINGA MIRANDA OTR/L” Practice Location

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