Provider Demographics
NPI:1699929752
Name:CORREA, JAIME ANTONIO (OTR-L)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ANTONIO
Last Name:CORREA
Suffix:
Gender:M
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:710 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3004
Mailing Address - Country:US
Mailing Address - Phone:305-302-4242
Mailing Address - Fax:305-349-0896
Practice Address - Street 1:2685 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-515-0892
Practice Address - Fax:954-349-0896
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13392225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics