MEDICARE: ALLYSA BARBIE CALERO 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	OT19180	FL

General Provider Information

NPI Number	:	1518450378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSA BARBIE CALERO OT

Provider Business Mailing Address
First Line	:	250 CATALONIA AVE STE 804
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6727
Country	:	US
Telephone Number	:	305-774-1788
Fax Number	:	305-774-1789

Provider Business Practice Location Address
First Line	:	250 CATALONIA AVE STE 804
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6727
Country	:	US
Telephone Number	:	305-774-1788
Fax Number	:	305-774-1789

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

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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