Provider Demographics
NPI:1558514034
Name:DIAZ, MAURY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MAURY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16239 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6131
Mailing Address - Country:US
Mailing Address - Phone:917-664-2863
Mailing Address - Fax:917-591-2863
Practice Address - Street 1:16239 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6131
Practice Address - Country:US
Practice Address - Phone:917-664-2863
Practice Address - Fax:917-591-2863
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011607-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics