Provider Demographics
NPI:1003037268
Name:QUIAMBAO, CARINA
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:QUIAMBAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 AZALEA RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5064
Mailing Address - Country:US
Mailing Address - Phone:407-523-6987
Mailing Address - Fax:
Practice Address - Street 1:2445 ALCLOBE CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-8970
Practice Address - Country:US
Practice Address - Phone:407-295-6966
Practice Address - Fax:407-295-6966
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT12537OtherOCCUPATIONAL THERAPY LICE