Healthcare Provider Details

I. General information

NPI: 1174300164
Provider Name (Legal Business Name): OTROKHEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SUNNY ISLES BLVD UNIT 503
SUNNY ISLES BEACH FL
33160-4399
US

IV. Provider business mailing address

200 SUNNY ISLES BLVD UNIT 503
SUNNY ISLES BEACH FL
33160-4399
US

V. Phone/Fax

Practice location:
  • Phone: 646-912-1331
  • Fax:
Mailing address:
  • Phone: 646-912-1331
  • 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: ROKHEL MIRZAYEVA
Title or Position: OCCUPATIONAL THERAPY
Credential: OTR/L
Phone: 646-912-1331