Provider Demographics
NPI:1407204092
Name:OTERO, MARICELYS
Entity Type:Individual
Prefix:
First Name:MARICELYS
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 W OKEECHOBEE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2139
Mailing Address - Country:US
Mailing Address - Phone:786-709-1921
Mailing Address - Fax:
Practice Address - Street 1:9811 W OKEECHOBEE RD APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2139
Practice Address - Country:US
Practice Address - Phone:786-709-1921
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician