Provider Demographics
NPI:1407043854
Name:MEDINA, RAFAEL ENRIQUE (OTR / L)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ENRIQUE
Last Name:MEDINA
Suffix:
Gender:M
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 1:4000 PONCE DELEON BLVD. #470
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-777-0342
Mailing Address - Fax:866-816-9797
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 33428
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-470-2205
Practice Address - Fax:561-470-2215
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist