Provider Demographics
NPI:1497156491
Name:DIAZ, MAIDEL (OT19265)
Entity Type:Individual
Prefix:
First Name:MAIDEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OT19265
Other - Prefix:
Other - First Name:MAIDEL
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 331934
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-1934
Mailing Address - Country:US
Mailing Address - Phone:786-452-0774
Mailing Address - Fax:
Practice Address - Street 1:3655 NW 107TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4328
Practice Address - Country:US
Practice Address - Phone:786-452-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19265225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist