Individual
MARITZA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA, LMT
Contact information
Practice address
1031 SW 109TH AVE, PEMBROKE PINES, FL 33025-5506
(786) 356-4844
Mailing address
1031 SW 109TH AVE, PEMBROKE PINES, FL 33025-5506
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11093
FL
225700000X
Massage Therapist
MA35505
FL
Other
Enumeration date
01/30/2010
Last updated
01/30/2010
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