Healthcare Provider Details

I. General information

NPI: 1043920424
Provider Name (Legal Business Name): LINDA JEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 SW 136TH ST STE 205
MIAMI FL
33186-8321
US

IV. Provider business mailing address

13501 SW 136TH ST STE 205
MIAMI FL
33186-8321
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-4321
  • Fax:
Mailing address:
  • Phone: 305-209-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-211758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: