Provider Demographics
NPI:1528194503
Name:SOLIS, JOSE DAVID (OTR)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DAVID
Last Name:SOLIS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19509 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6272
Mailing Address - Country:US
Mailing Address - Phone:954-499-0894
Mailing Address - Fax:
Practice Address - Street 1:7750 W 26TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5698
Practice Address - Country:US
Practice Address - Phone:305-231-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist