Provider Demographics
NPI:1013308048
Name:CRISTANCHO, PIEDAD GABRIELA (OT)
Entity Type:Individual
Prefix:
First Name:PIEDAD
Middle Name:GABRIELA
Last Name:CRISTANCHO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15025 NW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6852
Mailing Address - Country:US
Mailing Address - Phone:786-313-7800
Mailing Address - Fax:786-313-7803
Practice Address - Street 1:15025 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6852
Practice Address - Country:US
Practice Address - Phone:786-313-7800
Practice Address - Fax:786-313-7803
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist