Healthcare Provider Details

I. General information

NPI: 1194470914
Provider Name (Legal Business Name): GEORGE MEKKRI OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11735 SW 138TH AVE
MIAMI FL
33186-9094
US

IV. Provider business mailing address

11735 SW 138TH AVE
MIAMI FL
33186-9094
US

V. Phone/Fax

Practice location:
  • Phone: 305-298-5867
  • Fax:
Mailing address:
  • Phone: 305-298-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: