Provider Demographics
NPI:1326184656
Name:SERRANO, MYRNA ESTHER (OTR/L)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:ESTHER
Last Name:SERRANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 GOSHAWK PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-6101
Mailing Address - Country:US
Mailing Address - Phone:813-677-8237
Mailing Address - Fax:
Practice Address - Street 1:2215 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4432
Practice Address - Country:US
Practice Address - Phone:813-239-1179
Practice Address - Fax:813-436-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10866283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren