Provider Demographics
NPI:1386747293
Name:MEDINA, CARMEN (OT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2413 QUIET WATERS LOOP
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4789
Mailing Address - Country:US
Mailing Address - Phone:407-625-7652
Mailing Address - Fax:
Practice Address - Street 1:2413 QUIET WATERS LOOP
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4789
Practice Address - Country:US
Practice Address - Phone:407-625-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8203OtherBC/BS