MEDICARE: ILEANSY OTERO

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	235Z00000X	Speech-Language Pathologist	SA13143	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609176866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANSY OTERO

Provider Business Mailing Address
First Line	:	860 W 36TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5164
Country	:	US
Telephone Number	:	786-768-6499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-827-7344
Fax Number	:	305-827-7382

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

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	03/04/2015

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Directions to “ ILEANSY OTERO ” Practice Location

Language	Start Address	Practice Location

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