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General NPI Number Information
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NPI Number | 1104297217
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Entity Type | Organization
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Legal Business Name | PREMA FOR KIDS CORP.
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1250 E HALLANDALE BEACH BLVD SUITE 502
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4634
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Country | US
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Telephone | 786-546-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 E HALLANDALE BEACH BLVD SUITE 502
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4634
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Country | US
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Telephone | 786-546-0403
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | FABIANA MARTIN
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Credential | OTR
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Telephone | 786-546-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 12311
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 15207
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License Number State | FL
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