Provider Demographics
NPI:1881912079
Name:ECHEVARRIA, DAVID (COTA/L)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ECHEVARRIA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17190 SW 94TH AVE
Mailing Address - Street 2:APT #905
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4445
Mailing Address - Country:US
Mailing Address - Phone:786-355-3157
Mailing Address - Fax:
Practice Address - Street 1:1890 SW 57TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2164
Practice Address - Country:US
Practice Address - Phone:305-262-1987
Practice Address - Fax:305-262-1971
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10949224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant