Provider Demographics
NPI:1487123196
Name:REVILLA, CELIA DEBBIE (OTR/L)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:DEBBIE
Last Name:REVILLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 PASEO BLVD APT 1212
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5358
Mailing Address - Country:US
Mailing Address - Phone:954-517-8931
Mailing Address - Fax:
Practice Address - Street 1:12246 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7016
Practice Address - Country:US
Practice Address - Phone:954-517-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist