Healthcare Provider Details

I. General information

NPI: 1932273836
Provider Name (Legal Business Name): WALLIS ADLER CHEFITZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 SW 61ST CT
PINECREST FL
33156-1951
US

IV. Provider business mailing address

9315 SW 61ST CT
PINECREST FL
33156-1951
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-8586
  • Fax: 305-665-8586
Mailing address:
  • Phone: 305-665-8586
  • Fax: 305-665-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOT 462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: