Provider Demographics
NPI:1407221682
Name:MALDONADO AGUIRRE, DENISSE (OTA)
Entity Type:Individual
Prefix:MS
First Name:DENISSE
Middle Name:
Last Name:MALDONADO AGUIRRE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 FURTH RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7803
Mailing Address - Country:US
Mailing Address - Phone:321-604-8867
Mailing Address - Fax:
Practice Address - Street 1:1775 HUNTINGTON LN
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3136
Practice Address - Country:US
Practice Address - Phone:321-632-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 13951224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant