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General NPI Number Information
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NPI Number | 1982849253
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Entity Type | Organization
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Legal Business Name | SHOTTS QUALITY CARE, INC
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 16969 NW 67TH AVE SUITE 206
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City | HIALEAH
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State | FL
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Zip | 33015-4214
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Country | US
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Telephone | 305-364-4331
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Fax | 305-364-4332
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Provider Business Mailing Address
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Address Line | 16969 NW 67TH AVE SUITE 206
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City | HIALEAH
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State | FL
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Zip | 33015-4214
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Country | US
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Telephone | 305-364-4331
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Fax | 305-364-4332
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Authorized Official
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Title or Position | OWNER
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Name | IZASKU SHOTTS
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Credential | O.T.R/ L
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Telephone | 305-364-4331
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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 | OT13194
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License Number State | FL
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