MEDICARE: CHAUNTEL ALTIDOR

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	20475	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	:	1922647106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAUNTEL ALTIDOR

Provider Business Mailing Address
First Line	:	650 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3916
Country	:	US
Telephone Number	:	954-439-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3916
Country	:	US
Telephone Number	:	954-439-8892
Fax Number	:

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

Provider Enumeration Date	:	01/05/2020
Last Update Date	:	11/04/2025

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Directions to “ CHAUNTEL ALTIDOR ” Practice Location

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