Healthcare Provider Details

I. General information

NPI: 1750211876
Provider Name (Legal Business Name): AKEELAH OLIVIA THEOPHILUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W COPANS RD STE 310
MARGATE FL
33063-7700
US

IV. Provider business mailing address

8261 SW 6TH ST
NORTH LAUDERDALE FL
33068-2015
US

V. Phone/Fax

Practice location:
  • Phone: 888-668-5114
  • Fax:
Mailing address:
  • Phone: 954-931-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-538564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: