Basic Information
| Provider Information | |||||||||
| NPI: | 1114985124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUAREZ | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANASTASIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.O.T., OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 W CEDARWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347439021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212856404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3305 S ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523300 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 06/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | OT10037 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 888446300 | 05 | FL | MEDICAID | 189448 | 01 | FL | AMERIGROUP | OTHER |