Healthcare Provider Details

I. General information

NPI: 1619017357
Provider Name (Legal Business Name): BARBARA LAXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 SW 85TH AVE
MIRAMAR FL
33025-2190
US

IV. Provider business mailing address

1778 SW 85TH AVE
MIRAMAR FL
33025-2190
US

V. Phone/Fax

Practice location:
  • Phone: 954-540-5940
  • Fax:
Mailing address:
  • Phone: 954-540-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: