Provider Demographics
NPI:1710230644
Name:MILLARES, JOSE JR (OT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MILLARES
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4367 SW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4730
Mailing Address - Country:US
Mailing Address - Phone:954-445-2344
Mailing Address - Fax:
Practice Address - Street 1:21251 E DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1218
Practice Address - Country:US
Practice Address - Phone:954-445-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14902225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist