Provider Demographics
NPI:1982173308
Name:SANTIAGO-MALDONADO, PRISCILLA (OT, DC, CLT)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:SANTIAGO-MALDONADO
Suffix:
Gender:F
Credentials:OT, DC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17301 SW 149TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6748
Mailing Address - Country:US
Mailing Address - Phone:787-505-1943
Mailing Address - Fax:
Practice Address - Street 1:54 EMILY LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-2933
Practice Address - Country:US
Practice Address - Phone:787-505-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist