Provider Demographics
NPI:1295959278
Name:ADRIAZOLA, MIRIAM T
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:T
Last Name:ADRIAZOLA
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 1:16400 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1781
Mailing Address - Country:US
Mailing Address - Phone:786-259-4066
Mailing Address - Fax:
Practice Address - Street 1:2007 NE 40TH RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5122
Practice Address - Country:US
Practice Address - Phone:786-261-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist