Healthcare Provider Details

I. General information

NPI: 1467317743
Provider Name (Legal Business Name): EBAD KAZMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING RD STE 4B
HOLLYWOOD FL
33024-8067
US

IV. Provider business mailing address

11219 SW 147TH CT
MIAMI FL
33196-3342
US

V. Phone/Fax

Practice location:
  • Phone: 305-613-4141
  • Fax:
Mailing address:
  • Phone: 305-562-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT26698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: