Provider Demographics
NPI:1013484195
Name:ATAIDES, PATRYCJA (OTA)
Entity Type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:
Last Name:ATAIDES
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12080 SW 268TH ST UNIT 29
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8170
Mailing Address - Country:US
Mailing Address - Phone:786-380-9520
Mailing Address - Fax:
Practice Address - Street 1:13420 SW 314TH ST STE 169
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5541
Practice Address - Country:US
Practice Address - Phone:786-380-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14910224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant