MEDICARE: SHOTTS QUALITY CARE, INC

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	OT13194	FL

General Provider Information

NPI Number	:	1982849253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOTTS QUALITY CARE, INC

Provider Business Mailing Address
First Line	:	16969 NW 67TH AVE
Second Line	:	SUITE 206
City	:	HIALEAH
State	:	FL
Zip	:	33015-4214
Country	:	US
Telephone Number	:	305-364-4331
Fax Number	:	305-364-4332

Provider Business Practice Location Address
First Line	:	16969 NW 67TH AVE
Second Line	:	SUITE 206
City	:	HIALEAH
State	:	FL
Zip	:	33015-4214
Country	:	US
Telephone Number	:	305-364-4331
Fax Number	:	305-364-4332

Authorized Official
Title or Position	:	OWNER
Name	:	IZASKU SHOTTS
Credential	:	O.T.R/ L
Telephone Number	:	305-364-4331

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	12/15/2008

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