Provider Demographics
NPI:1790956076
Name:DE LA PASZ CORRAL, MARIA ELENA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:DE LA PASZ CORRAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA ELENA
Other - Middle Name:DE LA PAZ
Other - Last Name:CORRAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1091 PORT MALABAR BLVD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5100
Mailing Address - Country:US
Mailing Address - Phone:321-725-2405
Mailing Address - Fax:321-725-2406
Practice Address - Street 1:1091 PORT MALABAR BLVD NE STE 2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5100
Practice Address - Country:US
Practice Address - Phone:321-725-2405
Practice Address - Fax:321-725-2406
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist