Provider Demographics
NPI:1144274549
Name:AREVALO, EDITH ANDREA (OT)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:ANDREA
Last Name:AREVALO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 SW 68TH CT
Mailing Address - Street 2:APT G-8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1518
Mailing Address - Country:US
Mailing Address - Phone:305-740-0673
Mailing Address - Fax:
Practice Address - Street 1:12608 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1867
Practice Address - Country:US
Practice Address - Phone:305-412-4177
Practice Address - Fax:305-412-6301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist