Provider Demographics
NPI:1033235775
Name:MARCOS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARCOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 SW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3912
Mailing Address - Country:US
Mailing Address - Phone:305-332-5257
Mailing Address - Fax:305-386-8289
Practice Address - Street 1:756 W PALM DR
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3224
Practice Address - Country:US
Practice Address - Phone:305-246-3530
Practice Address - Fax:305-754-9223
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 1976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883761900Medicaid