Provider Demographics
NPI:1710130786
Name:OLMO, RAQUEL (OT/L)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:OLMO
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 LINBERRY LN
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4440
Mailing Address - Country:US
Mailing Address - Phone:407-353-4475
Mailing Address - Fax:
Practice Address - Street 1:6924 W LINEBAUGH AVE
Practice Address - Street 2:CHILDREN'S CHOICE FOR THERAPY INC.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5800
Practice Address - Country:US
Practice Address - Phone:813-962-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist