Provider Demographics
NPI:1629360615
Name:PALOMBA, MARCIA YAMADA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:YAMADA
Last Name:PALOMBA
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 1:15824 SW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3628
Mailing Address - Country:US
Mailing Address - Phone:305-606-2602
Mailing Address - Fax:
Practice Address - Street 1:14331SW 120TH TERRACE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3318
Practice Address - Country:US
Practice Address - Phone:786-212-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 14658225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist