Provider Demographics
NPI:1689723769
Name:PHILLIPS, MONICA RAQUEL (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:RAQUEL
Last Name:PHILLIPS
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 1:10350 SW 137TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6810
Mailing Address - Country:US
Mailing Address - Phone:305-408-8530
Mailing Address - Fax:
Practice Address - Street 1:9555 N KENDALL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1978
Practice Address - Country:US
Practice Address - Phone:305-596-5458
Practice Address - Fax:786-924-6336
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11243225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics