Provider Demographics
NPI:1154766111
Name:RICCOMBENI, MARIA AGOSTINA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AGOSTINA
Last Name:RICCOMBENI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13448 SW 154TH ST APT 2403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-8119
Mailing Address - Country:US
Mailing Address - Phone:305-300-0473
Mailing Address - Fax:
Practice Address - Street 1:4475 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2562
Practice Address - Country:US
Practice Address - Phone:305-200-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist