Provider Demographics
NPI:1861548067
Name:OSSABA-QUIROZ, LAKSMY MARCELA (MS)
Entity type:Individual
Prefix:MRS
First Name:LAKSMY
Middle Name:MARCELA
Last Name:OSSABA-QUIROZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 PEMBERTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5549
Mailing Address - Country:US
Mailing Address - Phone:352-556-8519
Mailing Address - Fax:352-515-1276
Practice Address - Street 1:9018 PEMBERTON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5549
Practice Address - Country:US
Practice Address - Phone:352-556-8519
Practice Address - Fax:352-515-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111424300Medicaid