Provider Demographics
NPI:1427397678
Name:BAVARESCO, ASTRID (OTA, MS CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ASTRID
Middle Name:
Last Name:BAVARESCO
Suffix:
Gender:F
Credentials:OTA, MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12595 SW 137TH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4222
Mailing Address - Country:US
Mailing Address - Phone:786-219-0151
Mailing Address - Fax:
Practice Address - Street 1:12595 SW 137TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4222
Practice Address - Country:US
Practice Address - Phone:786-219-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11547224Z00000X
FLSI25552355S0801X
FLSZ8926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant