Healthcare Provider Details

I. General information

NPI: 1154036499
Provider Name (Legal Business Name): BROOKE ABZUG OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

IV. Provider business mailing address

7747 WILDFLOWER SHORES DR
DELRAY BEACH FL
33446-2198
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 954-309-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT23846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: