Provider Demographics
NPI:1508694449
Name:MAXIMO, BEA KATRINA ABAYA
Entity type:Individual
Prefix:
First Name:BEA KATRINA
Middle Name:ABAYA
Last Name:MAXIMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEA KATRINA
Other - Middle Name:M
Other - Last Name:ANDRINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:950 PENINSULA CORPORATE CIR STE 3004
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1387
Mailing Address - Country:US
Mailing Address - Phone:561-501-1983
Mailing Address - Fax:561-270-6965
Practice Address - Street 1:950 PENINSULA CORPORATE CIR STE 3004
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1387
Practice Address - Country:US
Practice Address - Phone:561-501-1983
Practice Address - Fax:561-270-6965
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25353225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist