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General NPI Number Information
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NPI Number | 1760880207
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Entity Type | Organization
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Legal Business Name | SIDE BY SIDE THERAPY SERVICES
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 1117 E HALLANDALE BEACH BLVD SUITE # 3
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4488
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Country | US
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Telephone | 954-458-5040
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Fax | 954-455-4421
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Provider Business Mailing Address
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Address Line | 1117 E HALLANDALE BEACH BLVD SUITE # 3
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4488
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Country | US
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Telephone | 954-458-5040
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Fax | 954-455-4421
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST, DIRECTOR
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Name | RAQUEL FISBOIN
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Credential | MS, OTR/L
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Telephone | 954-458-5040
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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 | OT 14051
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License Number State | FL
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