Provider Demographics
NPI:1225214653
Name:OTERO, MAGALY (LMT)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N ORANGE AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2303
Mailing Address - Country:US
Mailing Address - Phone:407-835-8222
Mailing Address - Fax:407-835-0028
Practice Address - Street 1:150 N ORANGE AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2303
Practice Address - Country:US
Practice Address - Phone:407-835-8222
Practice Address - Fax:407-835-0028
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 41822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist