Provider Demographics
NPI:1164294716
Name:GARZON, MAIRA ALEJANDRA (OTR)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:ALEJANDRA
Last Name:GARZON
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 1:3300 NE 192ND ST APT PH4
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2427
Mailing Address - Country:US
Mailing Address - Phone:786-203-1369
Mailing Address - Fax:
Practice Address - Street 1:3300 NE 192ND ST APT PH4
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2427
Practice Address - Country:US
Practice Address - Phone:786-203-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist