Healthcare Provider Details

I. General information

NPI: 1962167122
Provider Name (Legal Business Name): KHALIL ANTON MRABE OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 SOUTH SOUTHGATE SHORES CR
TAMARAC FL
33321
US

IV. Provider business mailing address

8630 S SOUTHGATE SHORES CIR
TAMARAC FL
33321-8131
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-4171
  • Fax:
Mailing address:
  • Phone: 141-582-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: