Provider Demographics
NPI:1255349007
Name:MILLARES, ROBERT ALAN (OTRL CHT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:MILLARES
Suffix:
Gender:M
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SW 62 AVE
Mailing Address - Street 2:#120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-666-7116
Mailing Address - Fax:305-666-7168
Practice Address - Street 1:7000 SW 62 AVE
Practice Address - Street 2:#120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-666-7116
Practice Address - Fax:305-666-7168
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1366OtherBCBS
FLZ1366ZMedicare ID - Type Unspecified