Provider Demographics
NPI:1376082958
Name:CARRASQUILLO, LYVETTE CHARITY (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:LYVETTE
Middle Name:CHARITY
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1930
Mailing Address - Country:US
Mailing Address - Phone:786-804-2009
Mailing Address - Fax:
Practice Address - Street 1:4025 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-1930
Practice Address - Country:US
Practice Address - Phone:786-804-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020092800Medicaid