MEDICARE: MR. ROBERT MICHAEL RAIFMAN MOT, 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	OT10655	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z074B	OTHER	FL	BLUE CROSS/BLUE SHIELD FL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558471623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MICHAEL RAIFMAN MOT, OTR/L

Provider Business Mailing Address
First Line	:	3041 SE LEXINGTON LAKES DR
Second Line	:	#104
City	:	STUART
State	:	FL
Zip	:	34994-5400
Country	:	US
Telephone Number	:	772-287-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 SE LEXINGTON LAKES DR
Second Line	:	#104
City	:	STUART
State	:	FL
Zip	:	34994-5400
Country	:	US
Telephone Number	:	561-251-6769
Fax Number	:	772-287-7847

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/13/2009

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