Provider Demographics
NPI:1275925588
Name:HENAO, MARTHA LILIANA
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LILIANA
Last Name:HENAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9629 ORANGE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4513
Mailing Address - Country:US
Mailing Address - Phone:407-864-0820
Mailing Address - Fax:
Practice Address - Street 1:447 BELLA VIDA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6717
Practice Address - Country:US
Practice Address - Phone:321-961-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist