Provider Demographics
NPI:1972822310
Name:LACEWALA, ASMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:LACEWALA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17658 SW 28TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5563
Mailing Address - Country:US
Mailing Address - Phone:954-662-1799
Mailing Address - Fax:
Practice Address - Street 1:5979 NW 151ST ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2400
Practice Address - Country:US
Practice Address - Phone:305-362-3300
Practice Address - Fax:305-362-0202
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 6867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist