Healthcare Provider Details

I. General information

NPI: 1932094505
Provider Name (Legal Business Name): JEREMIE GELIN STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 NW 10TH AVE
NORTH MIAMI FL
33168-6601
US

IV. Provider business mailing address

13150 NW 10TH AVE
NORTH MIAMI FL
33168-6601
US

V. Phone/Fax

Practice location:
  • Phone: 305-850-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: