Individual
ROBERTO GENARO BANUELAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
558 N SEMORAN BLVD, WINTER PARK, FL 32792-2840
(407) 679-1515
Mailing address
30021 STATE ROAD 44, EUSTIS, FL 32736-9287
(352) 818-7720
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA14506
FL
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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