Provider Demographics
NPI:1235245093
Name:QUIAMBAO, EUGENE (OTR)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:QUIAMBAO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 AZALEA RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5064
Mailing Address - Country:US
Mailing Address - Phone:407-523-6987
Mailing Address - Fax:
Practice Address - Street 1:9436 AZALEA RIDGE WAY
Practice Address - Street 2:
Practice Address - City:GOTHA
Practice Address - State:FL
Practice Address - Zip Code:34734-5064
Practice Address - Country:US
Practice Address - Phone:407-523-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0006931225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889667400Medicaid