Provider Demographics
NPI:1245968395
Name:SANTOS, ANGELIE REBECCA MUEGA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELIE REBECCA
Middle Name:MUEGA
Last Name:SANTOS
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 1:18911 SW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2408
Mailing Address - Country:US
Mailing Address - Phone:954-865-9514
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5921
Practice Address - Country:US
Practice Address - Phone:786-717-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist