Healthcare Provider Details

I. General information

NPI: 1487219614
Provider Name (Legal Business Name): NAZIFA MAHBUB OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S FLAMINGO RD STE 101
DAVIE FL
33330-1902
US

IV. Provider business mailing address

5447 LUGO STREET
FORT PIERCE FL
34951
US

V. Phone/Fax

Practice location:
  • Phone: 954-312-3449
  • Fax:
Mailing address:
  • Phone: 646-255-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT19710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: