Provider Demographics
NPI:1790062800
Name:MANDADO, ALAIN (OTL)
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:MANDADO
Suffix:
Gender:
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19380 COLLINS AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2234
Mailing Address - Country:US
Mailing Address - Phone:305-879-6704
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 170
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2098
Practice Address - Country:US
Practice Address - Phone:786-633-5171
Practice Address - Fax:786-558-9279
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63588225700000X
FLOT19239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist