Provider Demographics
NPI:1275380685
Name:ALVAREZ, IVANA (COTA /L)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:COTA /L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SW 160TH AVE
Mailing Address - Street 2:APT.201
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:786-216-5453
Mailing Address - Fax:
Practice Address - Street 1:4311 SW 160TH AVE
Practice Address - Street 2:APT.201
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:786-216-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19771224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant