Healthcare Provider Details

I. General information

NPI: 1851086961
Provider Name (Legal Business Name): AVITAL GAVISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 NW 81ST TER
PARKLAND FL
33067-5013
US

IV. Provider business mailing address

5940 NW 81ST TER
PARKLAND FL
33067-5013
US

V. Phone/Fax

Practice location:
  • Phone: 561-400-8049
  • Fax:
Mailing address:
  • Phone: 561-400-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15836
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: