MEDICARE: JESSICA GOLAN MS,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	OT22833	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

General Provider Information

NPI Number	:	1558898668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GOLAN MS,OTR/L

Provider Business Mailing Address
First Line	:	3601 NE 168TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3590
Country	:	US
Telephone Number	:	305-336-4350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 NE 168TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3590
Country	:	US
Telephone Number	:	305-336-4350
Fax Number	:

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

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	04/15/2022

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