Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | OT16273 | FL |
N | 225XE0001X | Environmental Modification | OT16273 | FL |
N | 2251E1200X | Ergonomics | OT16273 | FL |
N | 225XE1200X | Ergonomics | OT16273 | FL |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT16273 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT16273 | FL |
NPI | 1265021992 |
---|---|
Provider Name | Dr. Kristian Carlos Llaca |
First Address | Pembroke Pines, FL 33028-1345 |
Second Address | Pembroke Pines, FL 33028-1345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2021 |
Last Update Date | 17/01/2021 |