Provider Demographics
NPI:1245570951
Name:DE OLIVEIRA, LEONARDO VALENTIM
Entity Type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:VALENTIM
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6232
Mailing Address - Country:US
Mailing Address - Phone:954-907-6783
Mailing Address - Fax:954-241-6726
Practice Address - Street 1:601 NW 96TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6232
Practice Address - Country:US
Practice Address - Phone:954-907-6783
Practice Address - Fax:954-241-6726
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12848224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant