Provider Demographics
NPI:1841219466
Name:CORONA, MARIA JUDITH (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JUDITH
Last Name:CORONA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 TORREMOLINOS AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2962
Mailing Address - Country:US
Mailing Address - Phone:786-355-8835
Mailing Address - Fax:
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 611
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-454-2345
Practice Address - Fax:954-457-8242
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3175225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5357BOtherMEDICARE SUPPLIER #