Healthcare Provider Details

I. General information

NPI: 1750110532
Provider Name (Legal Business Name): RENEE MARIE GRAZIADEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE GRAZIADEI OTR

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 NW 167TH ST
MIAMI LAKES FL
33014-6328
US

IV. Provider business mailing address

2750 SW 109TH TER
DAVIE FL
33328-1039
US

V. Phone/Fax

Practice location:
  • Phone: 305-756-9947
  • Fax: 305-756-9948
Mailing address:
  • Phone: 954-918-4059
  • Fax: 305-756-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT6089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: