Provider Demographics
NPI:1902544653
Name:LUBIN, MIRLANDE
Entity Type:Individual
Prefix:
First Name:MIRLANDE
Middle Name:
Last Name:LUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 PAGEANT WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2731
Mailing Address - Country:US
Mailing Address - Phone:407-307-8620
Mailing Address - Fax:
Practice Address - Street 1:5069 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8271
Practice Address - Country:US
Practice Address - Phone:321-303-6276
Practice Address - Fax:407-537-9772
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant