Provider Demographics
NPI:1578657243
Name:DE LAS POZAS, GEORGIA (OTR)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:DE LAS POZAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13441 SW 62ND ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5134
Mailing Address - Country:US
Mailing Address - Phone:305-798-3498
Mailing Address - Fax:
Practice Address - Street 1:13441 SW 62ND ST APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5134
Practice Address - Country:US
Practice Address - Phone:305-798-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 8736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004793200Medicaid
FLOT 8736Medicare UPIN