Provider Demographics
NPI:1356936439
Name:CAMILO, ROSARIO
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:CAMILO
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 1:2199 NW 77TH WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3694
Mailing Address - Country:US
Mailing Address - Phone:954-732-2152
Mailing Address - Fax:
Practice Address - Street 1:10075 S JOG RD STE 201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-733-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty