Provider Demographics
NPI:1215359344
Name:REYES, MAVIS (OTR)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:REYES
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 1:14750 SW 26TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5937
Mailing Address - Country:US
Mailing Address - Phone:786-416-2106
Mailing Address - Fax:786-615-9608
Practice Address - Street 1:14750 SW 26TH ST STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5937
Practice Address - Country:US
Practice Address - Phone:305-220-8222
Practice Address - Fax:786-615-9608
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist