Provider Demographics
NPI:1992414296
Name:CORREA, MARTHA CECILIA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CECILIA
Last Name:CORREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8368 SW 152ND AVE APT 42
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4088
Mailing Address - Country:US
Mailing Address - Phone:786-319-6190
Mailing Address - Fax:
Practice Address - Street 1:5470 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2105
Practice Address - Country:US
Practice Address - Phone:305-456-2646
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist