MEDICARE: LAUREN LEIVA MOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT14052	FL

General Provider Information

NPI Number	:	1063806370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LEIVA MOT

Provider Business Mailing Address
First Line	:	9702 NW 46TH MANOR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076
Country	:	US
Telephone Number	:	954-803-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	9702 NW 46TH MNR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2604
Country	:	US
Telephone Number	:	954-803-8035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	03/25/2015

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