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General NPI Number Information
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NPI Number | 1811350051
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Entity Type | Organization
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Legal Business Name | MABAKA LLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 6752 HERITAGE GRANDE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-7926
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Country | US
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Telephone | 561-251-5190
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Fax | 561-210-4304
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Provider Business Mailing Address
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Address Line | 6752 HERITAGE GRANDE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-7926
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Country | US
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Telephone | 561-251-5190
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Fax | 561-210-4304
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Authorized Official
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Title or Position | MANAGING MEMEBER
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Name | MS. MADELINE BARO KAHAN
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Credential | MOT, OTRL
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Telephone | 561-251-5190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT10006
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License Number State | FL
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