Healthcare Provider Details

I. General information

NPI: 1568221240
Provider Name (Legal Business Name): RACHEL MEDEROS BADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 201
BOYNTON BEACH FL
33437-3536
US

IV. Provider business mailing address

721 NE 51ST CT
DEERFIELD BEACH FL
33064-4851
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-1012
  • Fax:
Mailing address:
  • Phone: 954-470-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOAT19802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: