Provider Demographics
NPI:1659829463
Name:INNOCENT, TATIANA (OT)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:INNOCENT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11069 NW 80TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6001
Mailing Address - Country:US
Mailing Address - Phone:305-965-2213
Mailing Address - Fax:
Practice Address - Street 1:1550 W 84TH ST
Practice Address - Street 2:STE 58
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3377
Practice Address - Country:US
Practice Address - Phone:305-985-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17911225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist