Healthcare Provider Details

I. General information

NPI: 1518020346
Provider Name (Legal Business Name): CHRISTINE BETANCOURT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SW 80TH ST #107
SOUTH MIAMI FL
33143-4661
US

IV. Provider business mailing address

6601 SW 80TH ST #107
MIAMI FL
33143-4661
US

V. Phone/Fax

Practice location:
  • Phone: 305-680-9707
  • Fax: 305-680-9707
Mailing address:
  • Phone: 305-283-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: