MEDICARE: KELLY PARRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1701	FL

General Provider Information

NPI Number	:	1114311404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY PARRA

Provider Business Mailing Address
First Line	:	3801 N 40TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1860
Country	:	US
Telephone Number	:	954-589-5127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 N 40TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1860
Country	:	US
Telephone Number	:	954-589-5127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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Directions to “ KELLY PARRA ” Practice Location

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