MEDICARE: LUZ E. VALLE 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	225XG0600X	Gerontology Occupational Therapist	OT4792	FL

General Provider Information

NPI Number	:	1851631311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ E. VALLE OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 13445
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34979-3445
Country	:	US
Telephone Number	:	561-281-4491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 ELEVEN MILE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-2503
Country	:	US
Telephone Number	:	561-281-4491
Fax Number	:

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

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	02/20/2013

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Directions to “ LUZ E. VALLE OTR/L” Practice Location

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