Provider Demographics
NPI:1346789096
Name:LOUIDOR, WILSIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:WILSIE
Middle Name:
Last Name:LOUIDOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 CORAL WAY
Mailing Address - Street 2:602
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2631
Mailing Address - Country:US
Mailing Address - Phone:305-856-1999
Mailing Address - Fax:
Practice Address - Street 1:2153 CORAL WAY
Practice Address - Street 2:602
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2631
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant