Provider Demographics
NPI:1093366759
Name:CAMACHO, CARLOS DAVID (OTR)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:DAVID
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 S GRAND DUKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6330
Mailing Address - Country:US
Mailing Address - Phone:954-662-8430
Mailing Address - Fax:
Practice Address - Street 1:9821 S GRAND DUKE CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6330
Practice Address - Country:US
Practice Address - Phone:954-662-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist