Provider Demographics
NPI:1497422901
Name:CORDERO DELGADO, KIRIAM (OT)
Entity Type:Individual
Prefix:
First Name:KIRIAM
Middle Name:
Last Name:CORDERO DELGADO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 PARADISE ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3766
Mailing Address - Country:US
Mailing Address - Phone:787-415-2783
Mailing Address - Fax:
Practice Address - Street 1:30054 SW 158TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3448
Practice Address - Country:US
Practice Address - Phone:954-612-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty