Provider Demographics
NPI:1851621825
Name:BERDUGO, KRISTEL MARIANNE (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:MARIANNE
Last Name:BERDUGO
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 1:1221 SW 27TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4765
Mailing Address - Country:US
Mailing Address - Phone:786-486-0285
Mailing Address - Fax:305-260-9177
Practice Address - Street 1:1221 SW 27TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4765
Practice Address - Country:US
Practice Address - Phone:786-486-0285
Practice Address - Fax:305-260-9177
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13476225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT13475OtherSTATE OF FLORIDA