Healthcare Provider Details

I. General information

NPI: 1538529441
Provider Name (Legal Business Name): JENNIFER MEJIA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 SW 95TH AVE STE 204
MIAMI FL
33157-3459
US

IV. Provider business mailing address

16201 SW 95TH AVE STE 204
MIAMI FL
33157-3459
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-0384
  • Fax: 305-767-1461
Mailing address:
  • Phone: 786-732-0384
  • Fax: 305-767-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT20162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: