Healthcare Provider Details

I. General information

NPI: 1629204631
Provider Name (Legal Business Name): JOEL ISAIAH KUTTLER OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NE 105TH ST APT 203
MIAMI SHORES FL
33138-2139
US

IV. Provider business mailing address

1700 NE 105TH ST APT 203
MIAMI SHORES FL
33138-2139
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-6507
  • Fax:
Mailing address:
  • Phone: 305-984-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: