Provider Demographics
NPI:1871842088
Name:GUARINO, RAQUEL S (OT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:S
Last Name:GUARINO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:C
Other - Last Name:SOUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 40767
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0767
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:904-391-5807
Practice Address - Street 1:1325 SAN MARCO BLVD STE 102
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8549
Practice Address - Country:US
Practice Address - Phone:904-858-7045
Practice Address - Fax:904-858-7047
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01107176OtherRR MEDICARE
FLP01107176OtherRR MEDICARE