Provider Demographics
NPI:1033476056
Name:CONILLE, FABIOLA
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:CONILLE
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 1:3016 S OAKLAND FOREST DR APT 2906
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5610
Mailing Address - Country:US
Mailing Address - Phone:954-634-2354
Mailing Address - Fax:
Practice Address - Street 1:3016 S OAKLAND FOREST DR APT 2906
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5610
Practice Address - Country:US
Practice Address - Phone:954-634-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT15033225X00000X
FLOT15033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist