Provider Demographics
NPI:1508079922
Name:TABOADA, MIRAFLOR
Entity type:Individual
Prefix:
First Name:MIRAFLOR
Middle Name:
Last Name:TABOADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 TESLIN ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9085
Mailing Address - Country:US
Mailing Address - Phone:907-958-6628
Mailing Address - Fax:
Practice Address - Street 1:1584 MCNEIL ST STE 240
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8793
Practice Address - Country:US
Practice Address - Phone:253-549-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006855225X00000X
225X00000X
WAOT60188638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist