Provider Demographics
NPI:1447679568
Name:MALDONADO, OLGA LYDIA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:LYDIA
Last Name:MALDONADO
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 1:612 SANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7132
Mailing Address - Country:US
Mailing Address - Phone:813-453-8218
Mailing Address - Fax:
Practice Address - Street 1:612 SANFIELD ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7132
Practice Address - Country:US
Practice Address - Phone:813-453-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist