Provider Demographics
NPI:1386600245
Name:CARMO, CRISTIANE (OTR L)
Entity type:Individual
Prefix:
First Name:CRISTIANE
Middle Name:
Last Name:CARMO
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 1:2530 RIDGETOP WAY
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4223
Mailing Address - Country:US
Mailing Address - Phone:813-684-9985
Mailing Address - Fax:813-643-1387
Practice Address - Street 1:2530 RIDGETOP WAY
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594
Practice Address - Country:US
Practice Address - Phone:813-684-9985
Practice Address - Fax:813-643-1387
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3911222Q00000X
FLOT0003911225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885541200Medicaid
FL889657700Medicaid