Healthcare Provider Details

I. General information

NPI: 1417049735
Provider Name (Legal Business Name): MADHUMATTI MERHAI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 SORRENTO DR
WESTON FL
33326-4513
US

IV. Provider business mailing address

1461 SORRENTO DR
WESTON FL
33326-4513
US

V. Phone/Fax

Practice location:
  • Phone: 954-599-1405
  • Fax: 954-389-1408
Mailing address:
  • Phone: 954-599-1405
  • Fax: 954-389-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 11419
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberOT11419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: