Provider Demographics
NPI:1811015332
Name:MIRANDA, RONNA (OTR)
Entity Type:Individual
Prefix:MS
First Name:RONNA
Middle Name:
Last Name:MIRANDA
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 1:1519 IVYGATE LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2249
Mailing Address - Country:US
Mailing Address - Phone:239-293-5720
Mailing Address - Fax:
Practice Address - Street 1:2960 IMMOKALEE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1439
Practice Address - Country:US
Practice Address - Phone:239-514-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10197225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist