Provider Demographics
NPI:1104843754
Name:MUNOZ, ANDREA LEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LEE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 FLEMINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9260
Mailing Address - Country:US
Mailing Address - Phone:386-793-0612
Mailing Address - Fax:386-447-5281
Practice Address - Street 1:8851 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3329
Practice Address - Country:US
Practice Address - Phone:386-793-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT#10221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist