Healthcare Provider Details

I. General information

NPI: 1902208150
Provider Name (Legal Business Name): JOHN ALI BESHARAT OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6056 BOYNTON BEACH BLVD STE 215
BOYNTON BEACH FL
33437-3500
US

IV. Provider business mailing address

3001 W ROLLING HILLS CIR APT 302
DAVIE FL
33328-1913
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax:
Mailing address:
  • Phone: 305-562-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: