Provider Demographics
NPI:1457749814
Name:LASAGNA PEDIATRIC THERAPY
Entity type:Organization
Organization Name:LASAGNA PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:786-556-6222
Mailing Address - Street 1:13540 SW 108TH STREET CIR N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3349
Mailing Address - Country:US
Mailing Address - Phone:786-556-6222
Mailing Address - Fax:
Practice Address - Street 1:13540 SW 108TH STREET CIR N
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3349
Practice Address - Country:US
Practice Address - Phone:786-556-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887034900Medicaid