Provider Demographics
NPI:1871046904
Name:ALVARADO, CARLOS ROBERTO (OTR/L)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ROBERTO
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:ROBERTO
Other - Last Name:JUAREZ ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:501 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4554
Mailing Address - Country:US
Mailing Address - Phone:407-847-9110
Mailing Address - Fax:407-847-5579
Practice Address - Street 1:501 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4554
Practice Address - Country:US
Practice Address - Phone:407-847-9110
Practice Address - Fax:407-847-5579
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist