MEDICARE: JESSICA AYBAR BONETTI

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	224Z00000X	Occupational Therapy Assistant	OTA16460	FL

General Provider Information

NPI Number	:	1336897156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA AYBAR BONETTI

Provider Business Mailing Address
First Line	:	7817 CORAL BLVD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-5864
Country	:	US
Telephone Number	:	786-326-6431
Fax Number	:

Provider Business Practice Location Address
First Line	:	7817 CORAL BLVD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-5864
Country	:	US
Telephone Number	:	786-326-6431
Fax Number	:

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

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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Directions to “ JESSICA AYBAR BONETTI ” Practice Location

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