Provider Demographics
NPI:1508443623
Name:MABRY, DANIELA MARISOL (OTA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:MARISOL
Last Name:MABRY
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 1:5031 LOBLOLLY BAY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8731
Mailing Address - Country:US
Mailing Address - Phone:480-612-2617
Mailing Address - Fax:
Practice Address - Street 1:1935 STATE ROAD 436 STE 1005
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2244
Practice Address - Country:US
Practice Address - Phone:407-629-9455
Practice Address - Fax:407-629-9438
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18171224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM160173897970OtherDRIVER'S LICENSE