MEDICARE: LOW VISION THERAPY SERVICES OF MIAMI BEACH

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	OT10253	FL

General Provider Information

NPI Number	:	1396004289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOW VISION THERAPY SERVICES OF MIAMI BEACH

Provider Business Mailing Address
First Line	:	5600 COLLINS AVE
Second Line	:	APT 11P
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2411
Country	:	US
Telephone Number	:	305-865-3111
Fax Number	:	305-865-3111

Provider Business Practice Location Address
First Line	:	5600 COLLINS AVE
Second Line	:	APT 11P
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2411
Country	:	US
Telephone Number	:	305-865-3111
Fax Number	:	305-865-3111

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	DEBORAH LYNNE HALL
Credential	:	OTR/L
Telephone Number	:	305-865-3111

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/11/2012

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