=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205421948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ILANA EPSTEIN OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2021
-----------------------------------------------------
Last Update Date | 03/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8983 OKEECHOBEE BLVD STE 208
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-5145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-353-7650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 PROVIDENCE DR
-----------------------------------------------------
City | RICHBORO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18954-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-478-1201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 21529
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------