Provider Demographics
NPI:1114579463
Name:CASTILLO, INDIANA (OT)
Entity Type:Individual
Prefix:
First Name:INDIANA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 SW 10TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1833
Mailing Address - Country:US
Mailing Address - Phone:954-514-5447
Mailing Address - Fax:954-544-5445
Practice Address - Street 1:13460 SW 10TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1833
Practice Address - Country:US
Practice Address - Phone:954-514-5447
Practice Address - Fax:954-544-5445
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18240225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist