MEDICARE: KELLI FURTON OTR/L

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	225XP0200X	Pediatric Occupational Therapist	OT4253	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366496929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI FURTON OTR/L

Provider Business Mailing Address
First Line	:	400 NE 30TH ST
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33334-2053
Country	:	US
Telephone Number	:	954-564-7885
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NE 30TH ST
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33334-2053
Country	:	US
Telephone Number	:	954-564-7885
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/08/2008

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