Provider Demographics
NPI:1114271095
Name:PARRA, MIRIAM (OTR)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:PARRA
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 1:5932 MILFORD HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8819
Mailing Address - Country:US
Mailing Address - Phone:407-575-4636
Mailing Address - Fax:321-250-7425
Practice Address - Street 1:1300 KEVSTIN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5843
Practice Address - Country:US
Practice Address - Phone:407-575-4636
Practice Address - Fax:321-250-7425
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 1902225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics