Individual
JORGE FONTICIELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
8491 NW 17TH ST, DORAL, FL 33126-1025
(305) 456-5542
Mailing address
12342 SW 10TH LN, MIAMI, FL 33184-2445
(786) 312-6143
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
19536
FL
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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