Provider Demographics
NPI:1073900981
Name:FUQUENE, MARIA GIMENA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GIMENA
Last Name:FUQUENE
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 1:1501 NW 108TH AVE
Mailing Address - Street 2:APT 332
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6969
Mailing Address - Country:US
Mailing Address - Phone:954-240-5921
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 108TH AVE
Practice Address - Street 2:APT 332
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6969
Practice Address - Country:US
Practice Address - Phone:954-240-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT17015OtherOCCUPATIONAL THERAPIST