Provider Demographics
NPI:1760807267
Name:MENDIOLA-QUADRENY, SUSANA (OTR-L)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:MENDIOLA-QUADRENY
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 1:235 SIDONIA AVE
Mailing Address - Street 2:APT #107
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3281
Mailing Address - Country:US
Mailing Address - Phone:786-449-8283
Mailing Address - Fax:
Practice Address - Street 1:1380 N KROME AVE
Practice Address - Street 2:SUITE #110
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2406
Practice Address - Country:US
Practice Address - Phone:305-247-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist