MEDICARE: JENNIFER AVIDAN OTR/L

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	OT 13021	FL

General Provider Information

NPI Number	:	1265762959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AVIDAN OTR/L

Provider Business Mailing Address
First Line	:	3330 NE 190TH ST
Second Line	:	APT #1119
City	:	AVENTURA
State	:	FL
Zip	:	33180-2753
Country	:	US
Telephone Number	:	305-692-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	2642 COLLINS AVE
Second Line	:	SUITE 201
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-4738
Country	:	US
Telephone Number	:	305-890-4622
Fax Number	:

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

Provider Enumeration Date	:	01/03/2010
Last Update Date	:	01/03/2010

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