Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 10343 | FL |
NPI | 1073638359 |
---|---|
Provider Name | Mrs. Michelle S. Requena-Flores |
First Address | Homestead, FL 33033-5875 |
Second Address | Homestead, FL 33033-5875 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |