MEDICARE: RANDI ADLER THERAPY, INC.

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

General Provider Information

NPI Number	:	1720228638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDI ADLER THERAPY, INC.

Provider Business Mailing Address
First Line	:	1709 BELMONT LN
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-4285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1709 BELMONT LN
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-4285
Country	:	US
Telephone Number	:	754-234-7652
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RANDI ADLER
Credential	:
Telephone Number	:	754-234-7652

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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