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General NPI Number Information
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NPI Number | 1629651914
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Entity Type | Individual
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Provider Name | RAUL IVAN ACOSTA OTR
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Gender | Male
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 5190 NW 167TH ST STE 304
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6338
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Country | US
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Telephone | 305-756-9947
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Fax | 305-756-9948
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Provider Business Mailing Address
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Address Line | 140 LAKEVIEW DR APT 202
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City | WESTON
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State | FL
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Zip | 33326-2518
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Country | US
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Telephone | 305-879-3436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT21796
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License Number State | FL
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