Provider Demographics
NPI:1043208747
Name:BAEZ, AMY (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 BISCAYNE BLVD # 803
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33261-3479
Mailing Address - Country:US
Mailing Address - Phone:786-529-8847
Mailing Address - Fax:305-949-5480
Practice Address - Street 1:2050 NE 140TH ST APT 19
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1653
Practice Address - Country:US
Practice Address - Phone:786-529-8847
Practice Address - Fax:305-949-5480
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9623225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886282600Medicaid