Provider Demographics
NPI:1316383797
Name:IGLESIAS-MACHADO, VANESSA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:IGLESIAS-MACHADO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:IGLESIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16514 SW 48TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5141
Mailing Address - Country:US
Mailing Address - Phone:786-389-1762
Mailing Address - Fax:
Practice Address - Street 1:7232 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6624
Practice Address - Country:US
Practice Address - Phone:786-409-3254
Practice Address - Fax:786-452-7955
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008782700Medicaid