Provider Demographics
NPI:1790045243
Name:ANDINO, GRISELLE DEL CARMEN (OTR)
Entity Type:Individual
Prefix:
First Name:GRISELLE
Middle Name:DEL CARMEN
Last Name:ANDINO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 FOUNTAINBROOK BLVD
Mailing Address - Street 2:APT. 130
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7018
Mailing Address - Country:US
Mailing Address - Phone:407-453-2826
Mailing Address - Fax:
Practice Address - Street 1:12125 FOUNTAINBROOK BLVD
Practice Address - Street 2:APT. 130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7018
Practice Address - Country:US
Practice Address - Phone:407-453-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist