Provider Demographics
NPI:1669748455
Name:ALTAMIRANO, VALESSA V (OTR/L)
Entity type:Individual
Prefix:
First Name:VALESSA
Middle Name:V
Last Name:ALTAMIRANO
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 1:15200 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2521
Mailing Address - Country:US
Mailing Address - Phone:786-515-9771
Mailing Address - Fax:
Practice Address - Street 1:50 NW 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4266
Practice Address - Country:US
Practice Address - Phone:786-515-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist