MEDICARE: MS. MAURY DIAZ 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
1	225XP0200X	Pediatric Occupational Therapist	011607-1	NY

General Provider Information

NPI Number	:	1558514034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAURY DIAZ OTR/L

Provider Business Mailing Address
First Line	:	16239 NW 84TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-6131
Country	:	US
Telephone Number	:	917-664-2863
Fax Number	:	917-591-2863

Provider Business Practice Location Address
First Line	:	16239 NW 84TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-6131
Country	:	US
Telephone Number	:	917-664-2863
Fax Number	:	917-591-2863

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	06/03/2014

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