Provider Demographics
NPI:1144621442
Name:MORENO, DANIELA (COTA)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 NE 191ST ST APT 308
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4187
Mailing Address - Country:US
Mailing Address - Phone:786-859-3189
Mailing Address - Fax:
Practice Address - Street 1:1680 NE 191ST ST APT 308
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4187
Practice Address - Country:US
Practice Address - Phone:786-859-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13689224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant