Provider Demographics
NPI:1285319327
Name:PLASENCIA, IRENE (MOT/L)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:DE LA GUARDIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOT/L
Mailing Address - Street 1:11897 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2109
Mailing Address - Country:US
Mailing Address - Phone:561-818-8388
Mailing Address - Fax:
Practice Address - Street 1:3000 CENTRAL GARDENS CIR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8700
Practice Address - Country:US
Practice Address - Phone:561-600-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist