MEDICARE: MS. RONI LYNN O.T. 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 173	FL

General Provider Information

NPI Number	:	1669577748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RONI LYNN O.T. L

Provider Business Mailing Address
First Line	:	911 SAINT ANDREWS RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2920
Country	:	US
Telephone Number	:	954-983-1114
Fax Number	:	954-893-3733

Provider Business Practice Location Address
First Line	:	911 SAINT ANDREWS RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2920
Country	:	US
Telephone Number	:	954-983-1114
Fax Number	:	954-893-3733

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/09/2007

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