Healthcare Provider Details

I. General information

NPI: 1922487990
Provider Name (Legal Business Name): VALLERIE BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2015
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N NEW YORK AVE
WINTER PARK FL
32789-3117
US

IV. Provider business mailing address

11 EAGLE ROCK AVE STE 201
EAST HANOVER NJ
07936-3167
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-3700
  • Fax: 407-599-3701
Mailing address:
  • Phone: 973-887-9000
  • Fax: 973-887-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA11783
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number285096
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT20015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: