Provider Demographics
NPI:1164849394
Name:INTEGRATION OT IN PEDIATRICS
Entity Type:Organization
Organization Name:INTEGRATION OT IN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN-MANDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:786-510-0814
Mailing Address - Street 1:701 BRICKELL KEY BLVD
Mailing Address - Street 2:1607
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2674
Mailing Address - Country:US
Mailing Address - Phone:786-510-0814
Mailing Address - Fax:305-359-9261
Practice Address - Street 1:701 BRICKELL KEY BLVD
Practice Address - Street 2:1607
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2674
Practice Address - Country:US
Practice Address - Phone:786-510-0814
Practice Address - Fax:305-359-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4403225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004591600Medicaid