Provider Demographics
NPI:1376031096
Name:STA MARIA, PINKY RALLANG (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PINKY
Middle Name:RALLANG
Last Name:STA MARIA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:PINKY
Other - Middle Name:MERENCILLA
Other - Last Name:RALLANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10605 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-4704
Mailing Address - Country:US
Mailing Address - Phone:407-495-8840
Mailing Address - Fax:
Practice Address - Street 1:10605 MOORE RD
Practice Address - Street 2:
Practice Address - City:GOTHA
Practice Address - State:FL
Practice Address - Zip Code:34734-4704
Practice Address - Country:US
Practice Address - Phone:407-495-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist