Provider Demographics
NPI:1356832927
Name:DANIELE-SHAPIRO, KIMBERLY A (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:DANIELE-SHAPIRO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14541 VISTA VERDI RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6931
Mailing Address - Country:US
Mailing Address - Phone:305-962-1919
Mailing Address - Fax:
Practice Address - Street 1:92 SW 3RD ST APT 4302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3382
Practice Address - Country:US
Practice Address - Phone:305-962-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15350224Z00000X
FLOTR23596225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTR23596OtherOTR