Provider Demographics
NPI:1376661686
Name:OTERO, MIRTHIA LUZ (SLPD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRTHIA
Middle Name:LUZ
Last Name:OTERO
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10567 CRESTO DEL SOL CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3300
Mailing Address - Country:US
Mailing Address - Phone:407-325-7499
Mailing Address - Fax:
Practice Address - Street 1:10567 CRESTO DEL SOL CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3300
Practice Address - Country:US
Practice Address - Phone:407-325-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888863900Medicaid