Provider Demographics
NPI:1538700380
Name:MORALY, AUDREY Y (OTA)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:Y
Last Name:MORALY
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 1:1520 NW 140TH MNR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3011
Mailing Address - Country:US
Mailing Address - Phone:954-830-6838
Mailing Address - Fax:954-699-0600
Practice Address - Street 1:1520 NW 140TH MNR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3011
Practice Address - Country:US
Practice Address - Phone:954-830-6838
Practice Address - Fax:954-699-0600
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16964224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant